Tethered joint bearing implants and systems

ABSTRACT

An implant for resurfacing at least a portion of an articulation surface of a bone includes a body having a first side with a top articular surface and an opposing second side with a bone apposition surface. The bone apposition surface is adapted to bias against a natural or resected articulation surface of a bone. An elongated flexible first line is coupled to and extends from the body.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. Provisional Patent ApplicationSer. No. 60/586,706, filed Jul. 9, 2004, which is incorporated herein byspecific reference.

BACKGROUND OF THE INVENTION

1. The Field of the Invention

The present invention relates to tethered implants and systems formounting on a natural or resected articulation surface of an orthopedicjoint of a patient.

2. The Relevant Technology

The human body has a variety of movable orthopedic joints such as theknee joint, hip joint, shoulder joint, and the like. These joints areformed by the intersection of two bones. The intersecting end of eachbone has smooth articular surface that is comprised of cartilage. As aresult of injury, wear, arthritis, disease or other causes, it isoccasionally necessary to replace all or part of an orthopedic jointwith an artificial implant. This procedure is referred to as a jointreplacement or arthroplasty. For example, a total knee arthroplastycomprises cutting off or resecting the articular surfaces at both thedistal end of the femur and the proximal end of the tibia. Complementaryartificial implants are then mounted on the distal end of the femur andthe proximal end of the tibia. Where only a portion of a joint isdamaged, a partial joint arthroplasty can be performed. In thisprocedure, one or more artificial implants replace only a portion of ajoint.

Although joint replacement is now a common procedure that has met withpopular success, conventional implants and related mounting techniqueshave significant shortcomings. One significant drawback of many jointreplacements is the extended and painful patient recovery. For example,a traditional knee replacement requires an open procedure wherein arelatively large incision is made which severs a portion of the musclebounding the femur. The large incision is made so as to fully expose therespective ends of the femur and tibia.

This exposure is necessary when using conventional techniques to resectthe femur and tibia and to mount the implants. For example, someconventional tibial implants are screwed directly into the resected endface of the tibia. Mounting such screws requires exposure of theresected end face. In yet other embodiments, the implants are formedwith posts projecting therefrom. The posts are received within socketsformed on the resected end face of the tibia and femur. Again, formingof the sockets and inserting the posts into the sockets requiressubstantially full exposure of the resected end face of the tibia andfemur.

In general, the more invasive the surgery, the more painful, difficult,and time consuming the patient recovery. This is largely due to thesignificant amount of scar tissue produced by the incision and resectionof various soft tissues. Furthermore, such open and invasive surgerieshave a greater risk of infection.

Another problem with conventional joint implants and related techniquesfor mounting is that it can be difficult to fit, adjust, and/or exchangedifferent implants during the fitting stage. That is, implants come in avariety of different sizes, shapes, and configurations. During the jointprocedure, the surgeon may often test a variety of different sizedimplants to determine the best fit and alignment. As conventionalimplants are screwed into or pounded onto the bone during placement, thefitting, adjustment, and/or replacement of different conventionalimplants can be difficult and potentially damaging to the bone.Likewise, it can often be difficult to replace worn or damaged implants.

Accordingly, what is needed are implants and related methods and systemsfor preparing an articular surface of a joint and mounting an implantthereat which minimizes the length of incision, the amount of boneresection, and/or the impact on soft tissue. What is also needed areimplants and related methods and systems which enable easier fitting,alignment, testing, and/or replacement of implants.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the present invention will now be discussed withreference to the appended drawings. It is appreciated that thesedrawings depict only typical embodiments of the invention and aretherefore not to be considered limiting of its scope.

FIG. 1 is a perspective view of the proximal end of a tibia;

FIG. 2 is a perspective view of a guide assembly for forming a tunnel onthe proximal end of the tibia shown in FIG. 1;

FIG. 2A is a perspective view of an alternative template used with theguide assembly shown in FIG. 2;

FIG. 3 is a perspective view showing the guide assembly in FIG. 2mounted on the tibia of FIG. 1;

FIG. 4 is a perspective view of the tibia shown in FIG. 1 having atunnel formed thereon;

FIG. 5 is a perspective view of a rasp assembly resecting the tibia ofFIG. 4;

FIG. 6 is a top perspective view of the raps assembly shown in FIG. 5;

FIG. 7 is a bottom perspective view of the rasp assembly shown in FIG.6;

FIG. 8 is an exploded perspective view of the retention rod shown inFIG. 5;

FIGS. 9A and 9B are perspective views of the retention rod shown in FIG.8 being mounted to the rasp assembly shown in FIG. 5;

FIG. 10 is a perspective view of the tibia shown in FIG. 4 having arecess formed thereon;

FIG. 11 is a perspective view of a cutting template being mounted on thetibia shown in FIG. 4;

FIG. 12 is a perspective view of a tibial cutting guide positionedagainst a tibia;

FIG. 13 is a perspective view of a guide template mounted on a resectedsurface of the tibia shown in FIG. 12;

FIG. 14 is a bottom perspective view of the guide template shown in FIG.13;

FIG. 15 is a perspective view of a rasp mounted on the guide templateshown in FIG. 13;

FIG. 16 is a bottom perspective view of the rasp shown in FIG. 15;

FIG. 17 is a perspective view of the tibia shown in FIG. 13 after therasp is removed;

FIG. 18 is a perspective view of a centering template mounted on theguide template shown in FIG. 17;

FIG. 19 is a bottom perspective view of the centering template and guidetemplate shown in FIG. 18;

FIG. 20 is a perspective view of a tunnel guide;

FIG. 21 is a perspective view of the tunnel guide of FIG. 20 mounted onthe centering template and tibia shown in FIG. 18;

FIG. 22A is a top perspective view of a condylar implant;

FIG. 22B is a bottom perspective view of the condylar implant shown inFIG. 22A;

FIG. 22C is an exploded perspective view of the condylar implant shownin FIG. 22B;

FIG. 23A is an exploded perspective view of an alternative embodiment ofa condylar implant having two pockets;

FIG. 23B is a bottom perspective view of the implant shown in FIG. 23Awith a line for connecting thereto;

FIG. 24 is a bottom perspective view of another alternative embodimentof a condylar implant having three pockets;

FIG. 25 is a perspective view of a unitary condylar implant havingspikes formed thereon;

FIG. 26 is a cross sectional side view showing a wire attached to animplant by crimping;

FIG. 27 is a cross sectional side view showing a wire attached to animplant by looping around a hook;

FIG. 28 is a cross sectional side view showing a wire attached to animplant by passing through a constricted opening in the implant;

FIG. 29 is a cross sectional side view showing a wire attached to animplant by a set screw;

FIG. 30 is a cross sectional side view showing a wire attached to animplant by a barbed retainer;

FIG. 31 is a bottom perspective view of an alternative embodiment of animplant having a line slidably connected thereto;

FIG. 32A is a top exploded perspective view of a two piece condylarimplant having a linear track;

FIG. 32B is bottom exploded perspective view of the condylar implantshown in FIG. 32A;

FIG. 33A is a top exploded perspective view of a two piece condylarimplant having a curved track;

FIG. 33B is bottom exploded perspective view of the condylar implantshown in FIG. 33A;

FIG. 34 is an exploded view of an anchor assembly for securing acondylar implant to a tibia;

FIG. 35 is an enlarged perspective view of the anchor assembly shown inFIG. 34 including a bone anchor and a lock;

FIG. 36 is a cross sectional side view of the bone anchor shown in FIG.35;

FIG. 37 is an elevated front view of the lock shown in FIG. 35;

FIG. 38 is a cross sectional side view of the assembled anchor assemblyshown in FIG. 35 having a line extending therethrough;

FIG. 39 is a perspective view of an implant mounted on a tibia with theanchor assembly of FIG. 38 being mounted to the tibia;

FIG. 40 is an elevated front view of a tensioner;

FIG. 41 is an elevated side view of the tensioner shown in FIG. 40;

FIG. 42 is a perspective view of the tensioner shown in FIGS. 40 and 41coupled with the mounted anchor assembly shown in FIG. 39;

FIG. 43 is a perspective view of a system used to secure the implantshown in FIG. 31 to the tibia;

FIG. 44 is an exploded perspective view of an inventive full tibiaimplant for mounting on the proximal end of a tibia;

FIG. 45 is a perspective view of a guide template mounted on a medialcondyle of a femur and a milling head disposed within an opening of theguide template;

FIG. 46 is a perspective view of a rasp that is selectively used withthe guide template shown in FIG. 45;

FIG. 47 is a perspective view of the rasp shown in FIG. 46 being usedwith the guide template of FIG. 45;

FIG. 48 is a perspective view of the femur shown in FIG. 45 with acentering template mounted on the guide template and a tunneling guideseated on the centering template;

FIG. 49 is a top perspective view of a femoral condylar implant;

FIG. 50 is a bottom perspective view of the femoral condylar implantshown in FIG. 49 having a line connected thereto;

FIG. 51 is a perspective view of the system shown in FIG. 42 being usedto secure the femoral condylar implant of FIG. 49 to the femur;

FIG. 52 is a perspective view of an inventive femoral implant formounting on the distal end of a resected femur;

FIG. 53 is a perspective view of a femoral rasp assembly for resectingthe distal end of a femur;

FIG. 54 is a perspective view of an alternative embodiment of a femoralrasp assembly for resecting the distal end of a femur;

FIG. 55 is an inside perspective view of the femoral implant shown inFIG. 52;

FIG. 56 is a perspective view of the femoral implant shown in FIGS. 55mounted to the femur shown in FIG. 52;

FIG. 57 is a perspective view of an alternative embodiment of thefemoral implant;

FIG. 58 is a perspective view of a laterally bisected, two-piece femoralimplant in a disassemble state;

FIG. 59 is a perspective view of the implant shown in FIG. 58 in anassembled state;

FIG. 60 is a perspective view of an alternative embodiment of theimplant shown in FIGS. 58 and 59;

FIG. 61 is a perspective view of a longitudinally bisected, two-piecefemoral implant in a disassemble state;

FIG. 62 is a perspective view of the implant shown in FIG. 61 in anassembled state;

FIG. 63 is a perspective view of an alternative embodiment of theimplant shown in FIGS. 61 and 62;

FIGS. 64A-D are perspective views of another alternative embodiment of alaterally bisected, two-piece femoral implant;

FIG. 65 is a partial cross sectional side view of an inventive implantmounted on the proximal end of a femur;

FIG. 66 is a partial cross sectional side view of an inventive implanton the proximal end of a humerus; and

FIG. 67 is a partial cross sectional side view of an inventive implanton the distal end of a tibia.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The present invention relates to methods and apparatus for preparing anarticulation surface of an orthopedic joint to receive an implant,implants for mounting at an articulation surface of an orthopedic joint,anchoring systems for securing an implant at an articulation surface ofan orthopedic joint, and related methods and instruments. As used in thespecification and appended claims, the terms “articulation surface” and“natural articulation surface” are broadly intended to include allnatural articular surfaces of a bone forming a portion of an orthopedicjoint and all articulation wear surfaces of a bone forming a portion ofan orthopedic joint which are produced as a result of ware, trauma,disease, or other causes which remove all or a portion of the naturalarticular surface.

The implants, anchoring systems, instruments, and methods of the presentinvention can be used in combination to mount an inventive implant orcan be used separately or in combinations with other conventionalimplants, anchoring systems, instruments and/or methods. It isappreciated that the implants, anchoring systems, instruments, andmethods of the present invention can be used for mounting an implant onvirtually any articulation surface of any orthopedic joint in a human orother mammal. By way of example and not by limitation, the implants,anchoring systems, instruments, and methods of the present invention canbe used in association with resurfacing an articulation surface of aknee joint, ankle joint, hip joint, shoulder joint, elbow joint, wristjoint, interphalangeal joint, or other joints. As such, the implants canbe mounted on the proximal end and distal end of the femur, tibia,humerus, radius, and ulna, and on the articular surfaces of the scapula,pelvis, bones within the foot and hand, and other bone articularsurfaces. Likewise, the implants, anchoring systems, instruments, andmethods of the present invention can be used in facilitating a partialjoint arthroplasty or a total joint arthroplasty.

In one embodiment, the implants, anchoring systems, instruments, and/ormethods of the present invention are designed so that an articulationsurface of a joint can be prepared and an implant mounted thereon usingprocedures that are minimally invasive. As a result, recovery time issignificantly improved while the damage to soft tissue if decreased andthe risk of infection minimized. Also in one embodiment of the presentinvention, the implants, anchoring systems, instruments, and/or methodsare designed so that the implant can be selectively adjusted, tightened,and/or loosened after the implant is positioned on the articulationsurface. This ability allows for greater ease in adjustment and fittingof an implant at the time of initial placement and for greater easy inreplacement of an implant.

Set forth below are several embodiments of the present invention used inassociation with preparing an articulation surface at a proximal end ofa tibia and mounting a condylar implant at the proximal end of thetibia. It is again noted that these embodiments are only given by way ofexample and that one skilled in the art based on the teaching providedherein would be able to use corresponding implants, methods, andinstruments to prepare and/or mount an implant on other jointarticulation surfaces.

Depicted in FIG. 1 is a proximal end 10 of a tibia 12. Proximal end 10has a lateral side 14 and a medial side 16 which each extend between ananterior side 18 and a posterior side 19. Proximal end 10 furthercomprises a lateral condyle 20 and a medial condyle 21. Lateral condyle20 terminates proximally at a lateral facet 22 of a superior articularsurface of tibia 12 while medial condyle 21 terminates proximally atmedial facet 24 of a superior articular surface of tibia 12.

Although tibia 12 shown in FIG. 1 is from a left leg, it is appreciatedthat the tibia of the right leg has a complimentary configuration andthat the methods and apparatus of this specific example are equallyapplicable thereto. Furthermore, the methods and apparatus of thisexample are primarily illustrated in association with medial condyle 21of tibia 12. It is also appreciated that the methods and apparatus canbe used in association with lateral condyle 20.

In one embodiment, to facilitate mounting of a condylar implant onmedial condyle 21, conventional arthroscopic procedures are used toresect the posterior portion of the medial meniscus. Once the posteriorportion of the medial meniscus is removed, a vertical or horizontalincision, generally in a range between about 2 cm to about 6 cm, isformed over the anterior side of the medial meniscus. Followingretraction of the surrounding tissue, the anterior side of the medialmeniscus is resected. A coarse rasp is then inserted between the medialcondyle of the femur and medial condyle 21 of tibia 12. The rasp is usedto remove approximately 1-2 mm of articular cartilage on medial facet 24of tibia 12. Removal of the meniscus and the articular cartilageprovides increased access to medial facet 24 of tibia 12.

Depicted in FIG. 2 is one embodiment of a guide assembly 30 which is nowused for forming a tunnel through a portion of tibia 12. As discussedbelow in greater detail, the tunnel can be used for preparing tibia 12for a condylar implant and/or securing a condylar implant to tibia 12.In general, guide assembly 30 includes a substantially U-shaped guidebrace 32 having a template 34 and a tubular guide sleeve 36 mounted onopposing ends thereof. More specifically, guide brace 32 has a first end38 and an opposing second end 40. Recessed in first end 38 is a socket42.

Template 34 comprises a low profile base plate 44 having a top surface46 and an opposing bottom surface 48 which each extend between a firstend 50 and an opposing second end 52. Although not required, in oneembodiment bottom surface 48 has a configuration generally complementaryto medial facet 24 of the superior auricular surface of tibia 12. Baseplate 44 typically has a maximum thickness extending between surfaces 46and 48 in a range between about 1 mm to about 4 mm. Projecting fromsecond 52 of base plate 44 is a stem 54. Stem 54 is configured to beslidably received within socket 42 of guide brace 32. A catch 56downwardly extends from bottom surface 48 of base plate 44 at first end50. As depicted, catch 56 has the configuration of a narrow finger. Inother embodiments, catch 56 can comprise an elongated ridge or otherconfigurations.

Formed on second end 40 of guide brace 32 is an enlarged housing 60having a passage 62 extending therethrough. A resiliently flexible clamparm 64 is mounted to housing 60. An aperture 66 extends through clamparm 64 in general alignment with passage 62.

Tubular guide sleeve 36 slidably extends through passage 62 and aperture66. Guide sleeve 36 has a proximal end 68 and an opposing distal end 70.A plurality of sharpened teeth 72 are formed at distal end 70. Bypressing clamp arm 64 toward housing 60, passage 62 and aperture 66 arealigned allowing guide sleeve 36 to freely slide within passage 62 andaperture 66 to a desired location. As clamp arm 64 is released, clamparm 64 resiliently biases away from housing 60 so as to bind guidesleeve 36, thereby securing guide sleeve 36 in the desired location. Inalternative embodiments, it is appreciated that clamp arm 64 can bereplaced with a set screw, clamp, or a variety of other types offasteners that can be used to selectively secure guide sleeve 36 tosecond end 40 of guide brace 32.

During use, as depicted in FIG. 3, template 34 is slid over medial facet24 of tibia 12, i.e., the articulation surface, so that catch 56 catcheson posterior side 19 of tibia 12. Catch 56 thus facilitates properpositioning of template 34 and also helps to retain template 34 onmedial facet 24. It is appreciated that the size and shape of thelateral and medial facets of the superior articular surfaces of thetibia varies between different patients. As such, the present inventioncomprises a plurality of alternative templates 34 which are configuredfor placement on one of the lateral and medial facet and which each havea different configuration. As such a number of the alternative templates34 can be initially test fitted to determine one that has a best fit fora particular patient.

For example, depicted in FIG. 2A is one alternative template 34A that issmaller than template 34. Like elements between templates 34 and 34A areidentified by like reference characters. In further contrast to template34, template 34A has a catch 56A downwardly extending from second end 52of base plate 44. Catch 56A thus biases against anterior side 18 ormedial side 16 of tibia 12 to help properly position template 34A. Inyet other embodiments, in contrast to positioning the projection on oneof the opposing ends of base plate 44, the projection can be positionedalong one of the opposing sides of base plate 44 so as to bias againstlateral side 14 (when used on lateral facet 22) or bias against medialside 16 of tibia 12.

Once template 34 is selected and properly positioned on medial facet 24,tubular guide sleeve 36 is advanced within housing 60 so that teeth 72at distal end 70 bias against medial side 16 of proximal end 10 of tibia12. As such, tubular guide sleeve 36 biases against tibia 12 at alocation spaced apart from the articulation surface of medial facet 24.Guide sleeve 36 is then secured in place by releasing clamp arm 64. Bysecuring guide sleeve 36 against tibia 12, guide assembly 30 is clampedonto tibia 12. In one alternative embodiment, guide sleeve 36 can bebiased against anterior side 18 of tibia 12.

Next, a tubular drill sleeve 76 is inserted into tubular guide sleeve36. Positioned within drill sleeve 76 is a guide wire 78. Using drillsleeve 76 as a guide, guide wire 78 is drilled through tibia 12 untilguide wire 78 reaches template 34, thereby forming a guide tunnel. Inpart, template 34 functions as a shield to prevent guide wire 78 and/orother drill tools from accidentally contacting and damaging the femur.In other embodiments, a hole or recess is formed on template 34. Guidewire 78 can be passed through or into the hole or recess to ensurecomplete formation of the tunnel on medial facet 24.

Once the guide tunnel is formed, guide wire 78 and drill sleeve 76 areremoved from guide sleeve 60. A larger drill tool, not show, such as alarger guide wire, drill bit, or the like is then passed through guidesleeve 60 and drilled through tibia 12 along the guide tunnel to form afinal tunnel 90 (FIG. 4) through tibia 12. It is appreciated that anynumber of progressively larger drill tools can be used. In alternativeembodiments guide wire 78 and drill sleeve 76 can be eliminated. Asingle larger drill tool can then be used to form tunnel 90 in a singlepass. Using a sequence of larger drill tools, however, helps ensureproper placement of tunnel 90 and facilitates forming the opening of thetunnel adjacent to template 34.

As discussed below in greater detail, the angular orientation of tunnel90 is typically held constant and is based on the configuration of theimplant. However, depending on the amount of bone needed to be resectedfor mounting the condylar implant, it may be necessary to shift theposition of tunnel 90 posterior or anterior. Shifting the position oftunnel 90 posterior-anterior is accomplished by selectively moving stem54 of template 34 further into or further out of socket 42 of guidebrace 32. Once template 34 and guide brace 32 are positioned at theirrelative positions, a set screw 80 is tightened so as to secure template34 and guide brace 32 together. Predefined markings 82 are formed onstem 54 to help define the relative positioning between template 34 andguide brace 32.

Once tunnel 90 is formed, guide assembly 30 is removed so as to producetibia 12 shown in FIG. 4. As depicted, tunnel 90 has an interior surface92 that extends from a first end 94 to an opposing end second end 96.First end 94 is formed on medial side 16 of proximal end 10 of tibia 12.Second end 96 is formed on medial facet 24 of tibia 12. Expressed inother terms, second end 96 of tunnel 90 is formed on a section of anarticulation surface, i.e., medial facet 24, while first end 94 is at alocation on tibia 12 that is spaced apart from the articulation surface.Although tunnel 90 can be any desired size, in one embodiment tunnel 90has a diameter in a range between about 5 mm to about 10 mm.

Using the above discussed methods and instruments, tunnel 90 is formedby procedures that are minimally invasive to the patient. As discussedbelow in greater detail, once tunnel 90 is formed, tunnel 90 can then beused to assist in the resection of medial fact 24 and/or the mounting ofa condylar implant on the resected medial facet 24. Furthermore, byusing tunnel 90 the resection of medial facet 24 and the mounting of thecondylar implant can also be performed using procedures that areminimally invasive.

Although not required, in one embodiment as mentioned above, tunnel 90is used in the resection of tibia 12 for preparing tibia 12 to receive acondylar implant. The resection of tibia 12 can be accomplished using anumber of different procedures. For example, as depicted in FIG. 5, isone embodiment a rasp assembly 100 is used in association with aretention rod 102 to facilitate resection of tibia 12.

As depicted in FIG. 6, rasp assembly 100 comprises a rasp body 104having a pivot arm 105 mounted thereon, a rasp guide 106, and a coverplate 108. More specifically, as depicted in FIGS. 6 and 7, rasp body104 has a top surface 110 and an opposing bottom surface 112 that eachextend between a proximal end 114 and an opposing distal end 116.Transversely extending across bottom surface 112 are a plurality ofridges 118 that each terminate at a sharpened cutting edge 120. It isappreciated that ridges 118 and cutting edges 120 can be at any desiredorientation or combination of different orientation that facilitatecutting. Bottom surface 112 is configured such that reciprocatingmovement of bottom surface 112 on tibia 12 produces a recess on tibia 12that can receive a desired implant. Recessed on top surface 110 of raspbody 104 is a guide slot 122. Guide slot 122 is bounded by a floor 124and a sidewall 126 upstanding from floor 124. Extending through floor124 to bottom surface 112 is an opening 128.

Rasp guide 106 comprises a slide plate 130 having a top surface 131 andan opposing bottom surface 133. Downwardly projecting from bottomsurface 133 are a pair of spaced apart forks 132A and 132B with a pin134 extending therebetween. Forks 132A and B have facing interiorsurfaces 136 which bound a gap 137 and have opposing exterior surfaces138. Forks 132A and B terminate at a free terminus 140. Exterior surface138 of each fork 132A and B is recessed at terminus 140 such that asloping shoulder 142 is formed on each fork 132A and B.

Rasp guide 106 is received within guide slot 122 so that forks 132A andB project through opening 128. Rasp guide 106 is slightly smaller thanguide slot 122 such that forks 132A and B are free to reciprocate withinopening 128 as slide plate 130 reciprocates within guide slot 122. Asshown in FIG. 5, cover plate 108 is secured within guide slot 122 so asto retain rasp guide 106 within guide slot 122. Cover plate 108 can bemounted using conventional techniques such as welding, press fit, andthe like. Holes 144 are formed through cover plate 108 to preventunwanted build-up of resected bone particles within guide slot 122.

As depicted in FIG. 6, pivot arm 105 has a proximal end 146 and anopposing distal end 148. A set hole 149 extends through pivot arm 105toward proximal end 146. Distal end 148 of arm 105 is hingedly mountedto proximal end 114 of rasp body 104 by a pin 150.

In one embodiment, an insertion handle 160 is used to place rasp body104 over medial facet 24 of tibia 12. Insertion handle 160 has aproximal end 162 and an opposing distal end 164. A post 165 is formed aproximal end 162. Post 165 is adapted to receive an extension handle ifdesired. A pair of spaced apart lips 166A and B project from distal end164 and bound a slot 163. A channel 168 (FIG. 5) longitudinally extendsthrough insertion handle 160 so as to communicate with slot 163. Channel168 is configured to receive pivot arm 105 when rasp body 104 isreceived within slot 163.

During use, pivot arm 105 is slid into channel 165 from between lips166A and B. Lips 166A and B are then advanced to extend above and belowproximal end 114 of rasp body 104. A set screw 168 (FIG. 7) is thenadvanced into insertion handle 160 so as to extend through set hole 149on pivot arm 105. In this configuration insertion handle 160 rigidlysupports rasp body 104 so as to prevent hinged movement of rasp body 104during insertion.

Turning to FIG. 8, retention rod 102 comprises a tubular set rod 172bounding a channel 174 extending from a proximal end 176 to an opposingdistal end 178. Distal end 178 terminates at a distal end face 179. Ahandle 180 outwardly projects from proximal end 176 to facilitatinggrasping retention rod 102.

Retention rod 102 further comprises a hook rod 182. Hook rod 182 has aproximal end 184 and an opposing distal end 186. Projecting from distalend 186 is a hook 188. Threads 190 are formed on proximal end 184. Aknob 192 is also provided having a threaded port 193. Threads 190 onhook rod 182 are configured to mate with threaded port 193 of knob 192.Hook rod 182 is received within channel 174 of set rod 172 such thatknob 192 biases against handle 180 and hook 188 extends beyond distalend face 179. In this configuration, rotation of knob 192 relative tohook rod 182 causes hook 188 to extend or retract relative to set rod172.

During operation, as depicted in FIG. 5, rasp assembly 100 is mounted onmedial facet 24 of tibia 12. Rasp assembly 100 is positioned using therigidly mounted insertion handle 160, as discussed above, such thatforks 132A and B (FIG. 7) are aligned with the second end 96 of tunnel90. Once rasp assembly 100 is positioned, retention rod 102 is advancewithin tunnel 90 from first end 94. As depicted in FIG. 9A, knob 192 isrotated so that hook 188 extends beyond set rod 172. With hook 188freely exposed, hook 188 is hooked over pin 134 extending between forks132A and B.

As depicted in FIG. 9B, once hook 188 has captured pin 134, knob 192 isrotated so as to advance set rod 172 toward hook 188. Set rod 172 isadvanced until distal end face 179 of set rod 172 biases againstshoulders 142 of forks 132A and B. Shoulders 142 are sloped such thatend face 179 can sit flush against shoulder 142 while set rod 172retains its orientation within tunnel 90. In this configuration,retention rod 102 is securely fixed to rasp guide 106.

Once retention rod 102 is secured to rasp assembly 100, insertion handle160 is removed from pivot arm 105. A reciprocal driver, such as areciprocal saw, not shown, is then connected pivot arm 105. Whileholding rasp guide 106 substantially stationary by holding ontoretention rod 102, the reciprocal driver rapidly reciprocates rasp body104 so that cutting edges 120 resect medial facet 24 of tibia 12. In oneembodiment, rasp body 104 reciprocates along a length in a range betweenabout 1 mm to about 4 mm. Other dimensions can also be used.

In one embodiment bottom surface 112 of rasp body 104 slightly arched soas to be convex. By having pivot arm 105 hingedly attached to rasp body104, rasp body 104 is free to reciprocate along the arched path. Thehinged attachment also helps to minimize binding of rasp body 104. Inalternative embodiments, arm 105 can be rigidly attached to rasp body104.

In one embodiment of the present invention means are provided forremovably engaging retention rod 102 with rasp body 104 such that raspbody 104 can be selectively reciprocated without substantial movement ofretention rod 102. By way of example and not by limitation, oneembodiment of the means comprises rasp guide 106 slidably mounted onrasp body 104 and hook 188 mounted on retention rod 102. In alternativeembodiments it is appreciated that a variety of different structures canaccomplish the same function. For example, pin 134 and hook 188 can bereplaced with a threaded connection, bayonet connection, or any numberof other conventional connections which allows retention rod 102 toengage with rasp guide 106.

It is also appreciated that rasp guide 106 can be mounted on rasp body104 in a variety of different ways. For example, opening 128 can extendthrough rasp body 104 without the formation of guide slot 122. In thisembodiment slide plate 130 can be positioned directly on top surface 110of rasp body 104 while forks 132A and B extend through opening 128. Inyet another alternative, guide slot 122 can be formed on bottom surface112 of rasp body 104. Cover plate 108 can be formed having opening 128extending therethrough and cutting edges 120 formed on a bottom surfacethereof. Slide plate 130 can be positioned within the guide slot 122 sothat when cover plate 108 is secured over guide slot 122, forks 132A andB extend through opening 128 formed on cover plate 108.

It is also appreciated that retention rod 102 can have a variety ofdifferent configurations. For example, in alternative embodiments setrod 172 can be eliminated. As such, retention rod 102 can simplycomprise hook rod 182. Furthermore, as discussed above, hook 188 can bereplaced with a variety of different types of connectors.

Once medial facet 24 has been sufficiently resected by rasp body 104,rasp assembly 100 and retention rod 102 are removed. The resected boneparticles are removed by conventional flushing and suction. As depictedin FIG. 10, tibia 12 now has a resected recess 194 formed on medialfacet 24.

It is appreciated that the resection of tibia 12 can be accomplishedusing a variety of different techniques. For example, in one alternativedepicted in FIG. 11, the resection of tibia 12 is accomplished bycutting through an area bounded by a cutting template 200. Cuttingtemplate 200 comprises a plate 202 having a top surface 204 and anopposing bottom surface 206. In the embodiment depicted cutting template200 is configured to rest on lateral facet 22 of tibia 12. Of course,cutting template 200 can also be designed for resting on medial facet24.

Extending between opposing surfaces 204 and 206 are a plurality of guidespaces 208. Guide spaces 208 are formed so that when cutting template200 is positioned, guide spaces 208 are positioned over at least aportion of the facet to be resected. In the embodiment depicted, guidespaces 208 have the configuration of an elongated channel. As will bediscussed below in greater detail, the channels facilitate guidedreceipt of a cutting burr 210 which is used to selectively remove theunwanted bone. In alternative embodiments, depending on the type andsize of tool used to remove the bone, guide spaces 208 can come in avariety of different sizes, shapes, and orientations.

In one embodiment, although not required or shown, a second cuttingtemplate is provided having guide spaces extending therethrough. In thesecond cutting template, the guide spaces are aligned so as to bound thearea of the facet to be resected which was blocked by plate 202 ofcutting template 200. As a result, by sequentially using both cuttingtemplates, all or at least a greater proportion of the bone can beremoved by cutting burr 210. Additional cutting templates can also beused.

Cutting template 200 is used in association with retention rod 102 aspreviously discussed. In the embodiment depicted, handle 180 has adifferent configuration. During use, cutting template 200 is positionover lateral facet 22. Distal end 178 of set rod 172 is advanced throughtunnel 90 so that hook 188 of hook rod 182 projects out of set rod 172.Hook 188 is passed though a guide space 208 and then pulled back ontotop surface 204 of plate 202. A rib 212 upwardly projects from plate 202adjacent to guide space 208. Hook 188 is hooked over rib 212 so as toimprove the engagement between hook 188 and cutting template 200.

Once hook 188 is engaged to cutting template 200, knob 192 is rotated soas to bias set rod 172 against bottom surface 206 of template 200. As aresult, retention rod 102 is securely clamped to cutting template 200.Accordingly, by pulling retention rod 102, cutting template 200 issecurely held in place on lateral facet 22. Cutting burr 210 or someother form of drill bit is then advanced into and along each of guidespaces 208 so as to resect the portion of the bone directly below guidespace 208. As previously discussed, in one embodiment cutting template200 can be removed and replaced with a second template. Burr 100 canthen be passed through guide spaces of the second template to removefurther bone that was covered by cutting template 200.

In other alternatives, it is appreciated that once cutting template 200is removed, the remaining bone portion can be removed by sight and feelwithout the use of a template. In yet other embodiments, depending onthe type and amount of bone needed to be resected, a single template canbe rotated or shifted on lateral facet 22 so that the single template isused to remove the desired bone.

In one embodiment of the present invention, means are provided forremovably engaging retention rod 102 to cutting template 200 so thatretention rod 102 secures cutting template 200 to the lateral or medialfacet of tibia 12 when retention rod 102 is received within tunnel 90 oftibia 12. By way of example and not by limitation, one embodiment ofsuch means comprises hook 188 and guide space 208 which enables hook 188to engage with cutting template 200.

The present invention also envisions that there are a variety of otherstructures that can accomplish the same function. For example, the samestructures and techniques as discussed above for securing retention rod102 to rasp assembly 100 can also be used with cutting template 200.That is, in one alternative forks 132A and B with pin 134 can be mountedon bottom surface 206 of plate 202. Other connections such as threadedconnection, bayonet connections, and the like can also be used.

The present invention envisions still other instruments and methods thatcan be used to resect medial condyle 21. For example, depicted in FIG.12 is a guide 214. Guide 214 comprises rod 216 having an upper end 217and an opposing lower end 218. Adjustably mounted on lower end 218 ofrod 216 is a brace 219 having a v-shaped notch 220. Notch 220 isconfigured so that brace 219 can be securely held against the distal endof tibia 12. Adjustably mounted at the upper end of rod 216 is anadjustment mechanism 222. Adjustment mechanism 222 comprises anelongated body 223 having rod 216 slidably extending therethrough. Ahandle 224 and an adjacent trigger 225 are each connected to body 223.Trigger 225 is connected to a cam 226 which is spring biased against rod216. As such, by retracting trigger 225, cam 226 is pulled back andadjustment mechanism 222 can freely slide along rod 216. Once trigger225 is released, cam 226 is spring biased against rod 216, therebysecuring adjustment mechanism 222 in place.

A cutting guide 228 is connected to body 223 by a post 229.Alternatively, cutting guide 228 can be directly connected to body 223.Cutting guide 228 has an inside face 230 and an opposing outside face231. An elongated slot 232 extends between faces 230 and 231. Insideface 230 is contoured so as to closely fit against the anterior side ofmedial condyle 21.

During use, guide 214 is positioned against tibia 12 as shown in FIG.12. An operator uses handle 224 to biases guide 214 against tibia 12 sothat guide 214 is securely held in position. Once positioned, a blade onan oscillating saw (not shown) is advanced through slot 232 in cuttingguide 228. Using slot 232 as a guide, the blade on the oscillating sawis advanced anterior to posterior through the medial condyle 21 so as toform resected surface 234. The saw blade also cuts through the medialside of medial condyle 21. Cutting guide 228 is positioned so that thesaw blade removes the articular cartilage of medial condyle 21. Thus, inone embodiment cutting guide 228 is positioned so that slot 232 ispositioned at a distance typically in a range between 1 mm to about 4 mmbelow medial facet 24. Other dimensions can also be used.

Once the blade from the oscillating saw is removed, guide 214 is alsoremoved. A reciprocating sagittal saw is then used to cut from the topsurface of medial facet 24 down to resected surface 234 along thelateral edge of resected surface 234. The fully separated cut bone piececan then be removed from tibia 12 as shown in FIG. 12. It is appreciatedthat the medial meniscus can be removed prior to resection of medialcondyle 21, as previously discussed, or can simply be removedconcurrently with the above discussed resection of medial condyle. Inyet other embodiments, it is appreciated that resected surface 234 canbe formed through the use of an electric burr, mill, bone chisel, bonechipper or the like. The above resection process can be used incombination with the rasping process previously discussed. That is,either before or after forming tunnel 90, the oscillating saw or othertool can initially be used to remove the articular cartilage beforerasping. The option has the benefit of easy removal of the articularcartilage which can be difficult to remove by rasping. Furthermore, thetotal amount of material to be removed by rasping is reduced. Inaddition, the above resection process provides a planar surface on thetibia which is more convenient to work with when forming a pocket forthe implant.

As mentioned above, in one embodiment resected surface 234 is a furtherresected to form a contoured pocket in which the implant can be mounted.By way of example, depicted in FIGS. 13 and 14 is a guide template 236.Guide template 236 comprises a body 237 having a top surface 238 and anopposing bottom surface 239. Although not required, in the embodimentdepicted, surfaces 238 and 239 are each substantially flat and form athickness extending therebetween which is typically in a range betweenabout 0.5 mm to about 4 mm. Body 237 has an interior surface 240 whichencircles an opening 241 extending between surfaces 238 and 239.

Opening 241 has an area that corresponds to the size of the implant.Thus, opening 241 can be any size or shape depending on the size andshape of implant to be used. In the embodiment depicted, opening 241 hasan elongated configuration and typically has an area greater than about2 cm² and more commonly greater than 3 cm². Again, other sizes andshapes can be used. Furthermore, in alternative embodiments, body 237need not completely encircle opening 241. For example, a section of body237 bounding opening 241 can be eliminated.

Body 237 has an anterior side 248 and an opposing posterior side 249.Projecting from anterior side 248 is an elongated handle 242. Extendingalong bottom surface 239 of body 237 and handle 242 is a recessedchannel 244. Rotatably disposed within channel 244 is a shaft 245. Shaft245 has a first end 246 disposed at the free end of handle 244 and anopposing second end 247 disposed at posterior side 249 of body 237. Ahandle 250 is connected to first end 247 of shaft 245. Handle 250enables the user to easily rotate shaft 245 by selective movement ofhandle 250. Outwardly projecting from second send 247 of shaft 245 is acatch 252. By selective rotation of shaft 245, catch 252 can beselective moved between a first position wherein catch 252 is disposedin the same plane as body 237 and a second position, as shown in FIG.14, wherein catch 252 orthogonally projects below bottom surface 239 ofbody 237.

During use, catch 252 is initially oriented in the first position. Body237 can then be easily slid anterior to posterior along resected surface234. Catch 252 can then be rotated to the second position such thatcatch 252 catches on the posterior side of tibia 12. Catch 252 can thusbe used to facilitate proper placement and stabilization of guidetemplate 236 on resected surface 234. Once guide template 236 ispositioned, it is checked for proper fit. That is, body 237 shouldextend complimentarily around the perimeter edge of resected surface234. If not, guide template 236 is replaced with a guide template ofdifferent size and/or shape. In this regard, a plurality of guidetemplates 236 are provided having different sizes to fit patients ofdifferent size. It is also appreciated that guide template 236 can beconfigured to be adjustable in size and/or shape.

Although not required, in one embodiment means are provided for securingbody 237 to tibia 12. By way of example and not by limitation, a firsthole 254 and a second hole 256 are formed at two-spaced apart locationsalong or adjacent to anterior side 248 of body 237. The holes can alsobe formed on handle 242. A tubular sleeve 258 encircles and upwardlyprojects at an angle from each of holes 254 and 256. In part, sleeves258 function as a guide but are not required. A pair of screws 260 areprovided each having an enlarged head 261.

Once guide template 236 is appropriately positioned, screws 260 areadvanced through corresponding holes 254 and 256 so as to screw into theanterior side of tibia 12. As a result of using two-spaced apart screws260, guide template 236 is secured in place so as to prevent unwantedsliding or rotation. In alternatives embodiments, a single hole andscrew can be used or three or more holes and corresponding screws can beused. Furthermore, in contrast to using screws, other types of fastenerssuch as barbs, spikes, expansion bolts, staples, clamps, or the like canbe used to secure body 237 to tibia 12.

Turning to FIG. 15, once guide template 236 is secured in position, arasp 264 is positioned on guide template 236. As depicted in FIGS. 15and 16, rasp 264 comprises a head 266 having an elongated handle 267projecting therefrom. Head 266 includes an inside face 268 and anopposing outside face 269. Projecting from inside face 268 is a cuttingmount 270. Counting mount 270 comprises a base 272 projecting frominside face 268 and a plurality of cutting teeth formed on base 272.Cutting mount 270 has a configuration smaller than opening 241 on guidetemplate 236 such that cutting mount 270 can be received within opening241 as shown in FIG. 15 and can be reciprocated back and forth therein.

In one embodiment, cutting mount 270 reciprocally slides back and forthwithin opening 241 along a distance in a range between about 3 mm to 15mm. Other dimensions can also be used. Cutting mount 270 also has athickness which is greater than the thickness of body 237 of guidetemplate 236. As a result, cutting teeth 237 ride against resectedsurface 234 when cutting mount 270 is received within opening 241.During the reciprocating movement, guide template 236 functions as aguide for rasp 264 so that only the bone bounded within opening 241 canbe removed.

Furthermore, in the embodiment depicted cutting mount 270 is smallerthan head 266 such that an openly exposed portion of inside face 268encircles cutting mount 270. Head 266 has an outer perimeter generallycorresponding to the outer perimeter of body 237 of guide plate 236 suchthat head 266 extends over body 237 when cutting mount 270 is receivedwithin opening 241. As such, as cutting mount 270 is reciprocated withinopening 241, cutting teeth 273 cut away at the bone bounded withinopening 241. The bone is continually cut away until head 266 biasesagainst body 237, thereby precluding further advancement of cuttingmount 270 into opening 241. To enable the cut bone particles to escapefrom opening 241, a plurality of open channels 274 extend throughcutting mount 270 and head 266.

It is appreciated that rasp 264 can come in a variety of alternativeconfigurations. For example, instead of having base 272 extend from head266, cutting teeth 273 could be elongated so as to extend directly fromhead 266. Likewise, it is not necessary that head 266 outwardly projecton all sides of cutting mount 270 so as to overlay guide plate 236.Rather, discrete spaced apart sections of head 266 can be adapted tooverlay guide plate 236. In still other embodiments, head 266 can havethe same perimeter dimensions as cutting mount 270. In this embodiment,handle 267 would still overlay guide template 236. It is likewiseappreciated that the size and arrangement of channels 274 and cuttingteeth 273 can be modified in a variety of different configurations.

In one embodiment, cutting mount 270 has a rounded bottom surface thatoutwardly curves front to back and side to side. As a result, asdepicted in FIG. 17, once rasp 264 is removed, a rounded pocket 278 isformed on resected surface 234. It is appreciated that cutting mount 270can have a variety of different configurations so as to form pocket 278of a corresponding shape. As will be discussed below in greater detail,pocket 278 is configured to provide a best fit for mounting the implant.In alternative embodiments where the bottom of the implant issubstantially flat, rasp 264 need not be required in that resectedsurface 234 can be positioned at the desired level to receive theimplant. Alternatively, rasp 264 can be formed so that cutting mount 270has a substantially flat face. In yet other embodiments, cutting mount270 can be configured to form grooves, channels, slots or the like tofit corresponding projections extending from the implant.

Once the bone surface is prepared to receive the implant, a tunnel 400is formed intersecting with pocket 278 so that the implant can bemounted. Guide assembly 30, as previously discussed with regard to FIGS.2 and 3, can be used to form tunnel 400 either before or after theformation of pocket 278 in the same way that tunnel 90 was formed.

In an alternative method, a centering template 280 is mounted on guidetemplate 236. As depicted in FIGS. 18 and 19, centering template 280comprises a mounting plate 282 having an elongated handle 283 projectingtherefrom. Mounting plate 282 comprises an upper plate 284 having aninside face 285. Projecting from inside face 285 is a boss 286. Boss 286has a configuration complimentary to opening 241 of guide template 236.Furthermore, boss 286 is slightly smaller than inside face 285 of upperplate 284. As a result, when boss 286 is received within opening 241, asshown in FIG. 18, upper plate 284 extends over a portion of guide plate236. This coupling provides a fixed positioning of centering template280 relative to guide template 236. Projecting from boss 286 is acontact boss 288. Contact boss is positioned so as to be located overthe intended opening for tunnel 400. This location is typically at thecenter of resected surface 234. Other locations, however, can also beused. As will be discussed below in greater detail, contact boss 288acts in part as a stop for the drill forming tunnel 400 within tibia 12so that the drill does not damage the femur.

As depicted in FIG. 18, formed on outside face 287 of upper plate 284 invertical alignment with contact boss 288 is a centering indent 290. Asdiscussed below in greater detail, centering indent 290 is used inassociation with a tunnel guide for positioning the placement of tunnel400.

Depicted in FIG. 20 is one embodiment of a tunnel guide 370incorporating features of the present invention. Tunnel guide 370comprises a brace 372 having an inside face 382 and an opposing outsideface 383 that each extend between a first end 373 and an opposing secondend 374. Second end 374 has a channel 376 extending therethrough.Sideably disposed within channel 376 is a tubular guide sleeve 378. Aclamp arm 380 is coupled with brace 372 and resiliently biases againstguide sleeve 378. As such, by depressing clamp arm 380, guide sleeve 378can be selectively slide to a desired location and then secured inposition by release of clamp arm 380. An elongated slot 384 extendsalong the length of brace 372 at first end 373 and extends betweeninside face 381 and outside face 382.

Tunnel guide 370 further comprises an elongated alignment arm 386 havinga first end 388 slidably disposed within slot 384 and an opposing secondend 390. Second end 390 terminates at a rounded tip 391. An adjustmentknob 392 threadedly engages first end 388 of alignment arm to brace 372.Rotation of adjustment knob 392 in a first direction allows second endof alignment arm 386 to freely slide along slot 384. By rotatingadjustment knob 392 in the opposing direction, alignment arm 386 isrigidly clamped to brace 372. It is noted that guide sleeve 378 has acentral longitudinal axis 394 extending therethrough. Tunnel guide 370is configured such that independent of the placement of alignment arm386 along slot 384, axis 394 is always aligned with tip 391.

As depicted in FIG. 21, during operation tip 391 of alignment arm 386 isreceived within indent 290 of centering template 280. Because guidesleeve 378 is always aligned with tip 391, the surgeon is now free tobias the distal end of. guide sleeve 378 at any location on tibia 12 forwhich tunnel guide 370 can be adjusted. It is understood that tunnel 400will extend through tibia 12 between the location where the distal endof guide sleeve 378 is position and pocket 278 formed on resectedsurface 234. The surgeon is thus free to select the best location ontibia 12 for forming the tunnel. Such selection can take intoconsideration the area of best bone quality and the desired length andposition for tunnel 400. In the present embodiment, where the implant isbeing mounted on the medial condyle 21, guide sleeve 378 is shown beingbiased against lateral side 14 of tibia 12. In alternative embodiments,it is also appreciated that guide sleeve 378 can be biased againstanterior side 18 or medial side 16 of tibia 12.

Once guide sleeve 378 is biased against tibia 12, a guide wire 396 ispassed through guide sleeve 378 and then drilled through tibia 12 untilguide wire 396 contacts boss 288 (FIG. 19). As a result, a tunnel 400 isformed having a first end 402 located at a position spaced apart fromresected surface 234 and a second end 404 (FIG. 17) which extendsthrough pocket 278 on resected surface 234. As discussed below ingreater detail, tunnel 400 receives a flexible line that is mounted tothe implant. In one embodiment, passing the flexible line through tunnel400 requires tunnel 400 to have a diameter typically in a range between1 mm to about 3 mm. Of course, larger diameters can also be used.Accordingly, depending on the desired size for tunnel 400, guide wire396 can be used to independently form tunnel 400. Alternatively, atubular drill sleeve can be positioned over guide wire 396 to enlargetunnel 400. Alternatively, guide wire 396 can be removed and a largerdrill can be passed through the preliminary tunnel formed by the guidewire 396 to form the final tunnel 400.

As will be discussed below in greater detail, a bone anchor is securedwithin first end 402 of tunnel 400. The bone anchor requires a largeropening than what is necessarily needed for the line to pass throughtunnel 400. Accordingly, where the tunnel 400 is minimized to limit boneremoval, first end 402 of tunnel 400 is counter bored with a largerdrill so as to enable proper placement of the bone anchor. In oneembodiment, tunnel 400 can be counter sunk so as to have a diameter in arange between about 4 mm to 8 mm. Again, other dimensions can also beused.

Once tunnel 400 is formed, tunnel guide 370, centering template 280, andguide template 236 are removed from tibia 12. Accordingly, by using anyof the aforementioned methods and/or combinations thereof, a resectedmedial condyle having a tunnel coupled therewith, is now ready toreceive an implant.

Depicted in FIGS. 22A-22C is one embodiment of a condylar implant 300incorporating features of the present invention. The term “condylarimplant” is broadly intended to include implants that can replace all ora portion of a condyle of a tibia. The condylar implant can also replaceall or a portion of the articulation surface of the condyle.Accordingly, while the depicted embodiments show one conventional sizeand configuration for a condylar implant, in alternative embodiments thecondylar implant can be larger to replace more of the tibia or can besmaller to replace only a section of a condyle of a tibia. In suchalternatives, the condylar implant can have a variety of differentconfigurations.

In general, condylar implant 300 has a top articular surface 306 and anopposing bone apposition surface 303. In one embodiment, top articularsurface 306 has a generally concave contour so as to mate with acorresponding femoral condyle. Alternatively, articular surface 306 canbe substantially flat. Bone apposition surface 303 has a generallyconvex contour that curves front to back and side to side and that isconfigured to mate with pocket 278 on resected surface 234 (FIG. 17). Asa result of contouring bone apposition surface 303, implant 300 can beformed having a low profile configuration with a generally uniformthickness along the length thereof. This uniform thickness providesuniform strength for implant 300. Furthermore, by contouring implant 300to fit within pocket 278, the stability of mounted implant 300 isincreased so as to prevent unwanted movement of implant relative totibia 12.

In alternative embodiments, bone apposition surface 303 can besubstantially flat. As a result, implant 300 can be mounted directly onflat resected surface 234. In this embodiment, however, contouring ofarticular surface 306 would result in the opposing ends of implant 300being thicker than the middle. Again, however, depending on the size ofthe patient and the portion of the bone being replaced, implant 300 canhave an array of different sizes and configurations.

As depicted in FIG. 22C, implant 300 comprises a body 301 and an inlay320. Body 301 has top articular surface 306 and an opposing bottomsurface 308. A pocket 316 is recess on bottom surface 308. Pocket 316 isbounded by a floor 317 and a sidewall 318 upstanding around theperimeter thereof. A stem 304 projects from floor 317 and is completelyencircled by pocket 316. Body 301 is typically comprised of a metal suchas chromium, cobalt, titanium, or the like and alloys thereof but canalso be made of ceramics, plastics, or other materials. Body 301 canalso be comprised of layers or sections of different materials. In oneembodiment, body 301 has a maximum thickness typically in a rangebetween about 2 mm to about 10 mm. Other dimensions can also be useddepending on the amount that the tibial condyle is resected or wornaway.

Inlay 320 is secured within pocket 316 of body 301 so as to encirclestem 304. Inlay 320 is comprised of a porous bone ingrowth material suchas porous tantalum. Other conventional porous bone ingrowth materialscan also be used. Inlay 320 is secured within pocket 316 usingconventional techniques such as press fit, welding, adhesive, sintering,and the like. Inlay 320 can also be mechanically connected to body 301such as by screws, fasteners, rivets, or the like. In alternativeembodiments, pocket 316 can be eliminated and inlay 320 can be securedto the bottom surface of body 301 using various techniques. Inlay 320has an exposed bottom surface 322 that, as discussed above, can bearched, substantially flat, or can have any other desired configuration.In this embodiment, bottom surface 322 of inlay 320 comprisessubstantially all of bone apposition surface 303 of base plate 301.

In contrast to having a single pocket 316 in which a single inlay 320 ispositioned, it is appreciated that body 301 can be formed having aplurality of pockets each adapted to receive a separate inlay. Forexample, depicted in FIGS. 23A and B is an alternative embodiment of animplant 410 comprising a body 412 having a bottom surface 414. Bottomsurface 414 is formed with two pockets 416A and B which are partiallybounded by a perimeter sidewall 418 and are separated by a centralbridge 420. Each pocket 416A and B is adapted to receive a correspondinginlay 422A and B. In this embodiment, the bone apposition surfaceincludes not only the bottom surface of inlays 422A and B but also thebottom surface of bridge 420 and perimeter sidewall 418.

Similarly, depicted in FIG. 24 is an alternative embodiment of a body424 for an implant. Body has a bottom surface 424 with three separatepockets 426A, B, and C. Each of the pockets 426 is adapted to receive aseparate inlay. The bridges formed between the separate pockets provideincreased structural support for the implant and, as will be discussedbelow in greater detail, provide a structure on which the flexible linecan be attached.

In still other embodiments, it is appreciated that the inlay of porousbone ingrowth material can be eliminated. In this embodiment, thecondylar implant can comprise a single integral member. For example,depicted in FIG. 25 is an alternative embodiment of a condylar implant428. Implant 428 is formed as a single integral body 430 having toparticular surface 306 and an opposing bottom surface 430 which alsofunctions as the bone apposition surface. To facilitate secureattachment of implant 428 to tibia 12, a plurality of spikes 434 areformed on bottom surface 430. It is appreciated that in all of theembodiments herein that spikes, fins, or other forms of projections canalso be formed projecting from bottom surface of the implant. Suchprojections can be separated from or encircled by the porous boneingrowth inlay. The projections can also be formed on the porous boneingrowth inlay. Such projections can penetrate into the tibia or bereceived within slots formed on the tibia to help prevent unwantedmovement of the implant.

As previously mentioned, flexible line is used to secure the implants totibia 12. As used in the specification and append claims, the term“line” is broadly intended to include wire, cable, cord, suture, bradedline, combinations thereof or any other type of flexible filament. Theline can be made of metal, alloys, synthetics, composites, or any otherdesired material. In one embodiment of the present invention the linecomprises braded filaments of a cobalt chrome alloy having a diameter ina range between about 0.25 mm to about 5 mm with about 0.5 mm to about 3mm being more common and about 0.5 mm to about 2 mm being most common.Other dimensions can also be used. The line can be of any desiredlength.

In one embodiment, the line can also be defined in that for anunsupported length of line of 4 cm, the line has substantially nocompressive strength. In yet other embodiments, for an unsupportedlength of line of 4 cm, the line fails under buckling when an axialcompressive load of 0.25 N, 1 N, 2 N, 5 N, 20 N, or 50 N is applied.That is, different lines can be used that fail under different loads.Stiffer lines can also be used.

It is also appreciated that the line can be static or resilientlystretchable. In one embodiment where the line is resilientlystretchable, the line can be comprised of a material have shape memoryof pseudo elastic properties. One example of such a material is a nickeltitanium alloy sold under the name Nitinol. In yet other embodiment, itis appreciated that sections of the line could be replaced with a springmember such as a coiled spring or rubber or bungee type member.

Returning to FIGS. 22B and C, an elongated line 438 is provided having afirst end 439 and an opposing second end 440. First end 439 terminatesat a tip 441 that is sealed so as to have and maintain a smoothuniformed diameter. Second end 440 terminates at an enlarged roundedhead 442. In alternative embodiments, second end 440 can have the sameconfiguration as first end 439 or can have an enlarged head of anydesired configuration.

In one embodiment of the present invention, means are provided forconnecting flexible line 438 to implant 300. By way of example and notby limitation, stem 304 is provided with a threaded socket 312. Slidablydisposed on line 438 is a tubular retainer 444. Retainer 444 comprises abody 445 having one or more helical threads 446 mounted on the exteriorsurface thereof. Threads 446 are configured to engage with threadedsocket 312. A channel 448 longitudinally extends through body 445.Channel 448 constricts toward the distal end of body 445 so that thechannel 448 thereat is larger than the diameter of line 438 but smallerthan the diameter of head 442. The proximal end of channel 448 isenlarged and has a polygonal transverse cross section. As a result,first end 439 of line 438 can be passed through channel 448 of body 445distal to proximal. Line 438 can then be pulled through retainer 444until head 442 is stopped by the constricted section of channel 448. Thefirst end of line 438 can then be advanced through a central channel ina tubular driver (not shown) having a free end adapted to fit withinchannel 448 of retainer 444 at the proximal end thereof. The driver canthus be used to screw retainer 444 into threaded socket 312, therebysecuring line 438 to implant 300.

Depicted in FIG. 23B is another embodiment of the means for connecting aline to an implant. In this embodiment a passage 464 extends throughbridge 420. Passage 464 has an entrance 465 formed on a side wall ofbridge 420 and an exit 466 formed on a bottom surface of bridge 420.Again, passage 464 constricts as it extends from entrance 465 to exit466. Line 438 is shown having an enlarged substantially cylindrical head442 formed on second end 440. Head 442 is larger than the constrictedportion of passage 464. Head 442 can be crimped, welded, or otherwiseformed on line 438. Head 442 can also be integrally formed with line438. During assembly, first end 439 of line 438 is passed throughpassage 464 from entrance 465 to exit 466. Line 438 is advanced throughpassage 464 until head 442 is captured and securely retained withinconstricted passage 464. Inlays 422A and B can then be positioned withinpockets 416A and B. In yet other embodiments, rather than constrictingpassage 464, it is appreciated that head 442 can be wedge shaped so thathead 442 is captured within passage 464.

Depicted in FIGS. 26-31 are a variety of still other embodiments of themeans for connecting a line to an implant. Specifically, depicted inFIG. 26 is a stem 450 mounted to implant 300 which can be selectivelycrimped so as to catch head 442 within stem 450. In one embodiment thiscan be accomplished by forming slots along stem 450. Depicted in FIG.27, a hook 452 is formed projecting from the bottom surface of body 301of implant 300. In contrast to having head 442, a loop 454 is formed atthe second end of line 438. Loop 454 is looped around hook 452. Inlay320 is then mounted on the bottom surface of body 301 so as to preventloop 454 from accidentally sliding off of hook 452.

Depicted in FIG. 28, a channel 456 can be formed extending throughimplant 300 from top surface 306 to bottom surface 308. Channel 456 isenlarged at top surface 306 so as to receive head 442 of line 438 butconstricts toward bottom surface 308 so as to capture head 442 withinchannel 456. The opening to channel 456 on top surface 306 can berounded to prevent unwanted wear on the femoral condyle. In otherembodiments, a plug can be inserted within channel 456 so as to occludethe opening to channel 456. In still another alternative, instead offorming the opening to channel 456 on top surface 306, a constrictedslot can be formed that inwardly extends from the side of implant 300.

Depicted in FIG. 29, a set screw 458 is screwed into the side of atubular stem 459 to capture head 456 therein. Finally, depicted in FIG.30, rather than having a threaded retainer 444 as discussed above, atubular retainer 460 can be provided with outwardly projecting barbs461. Retainer 460 can simply be pushed into a socket 462 having threadsor barbs thereon so that retainer 460 is captured therein. It is alsonoted that in FIG. 30 line 438 is shown comprising a resilientlystretchable spring 468. It is appreciated the spring 468 can be directlyconnected to the implant or disposed along line 438. Spring 468 can alsocome a variety of different shapes and sizes and be made from differentmaterials. As will be discussed below in greater detail, spring 468helps maintain the desired tension force on line 438 so that the implantis securely held in position.

In the embodiment depicted in FIG. 31, an implant 470 has a body 471with a bottom surface 472. A pair of spaced apart projections 474A and Bproject from bottom surface 472. A passage 475 extends through eachprojection 474A and B. Line 438 is passed through each passage 475 sothat line 438 is slidably connected to implant 470 with both ends 439and 440 of line 438 being freely disposed. As will be discussed below ingreater detail, in this embodiment both ends 439 and 440 of line 438 areseparately connected to the bone. Since line 438 is slidably connectedto implant 470, this embodiment functions like a pulley in that atensioning force applied to one end of line 438 is magnified as ispasses through the passages 474. As such, greater force can be used tosecure the implant without increasing the load on line 438.

Furthermore, by connecting line 438 to implant 470 at two spaced apartlocations, the implant is secured in a more stable configuration thatprevents unwanted sliding or rotation on the bone. In other embodiments,it is appreciated that line 438 can be connected to only a singleprojection 474. It is also appreciated that a first line can beconnected to projection 474A while a second line is connected toprojection 474B. In like manner, it is appreciated that in allembodiment disclosed herein, two or more discrete lines can be connectedtwo each of the implants using any of the methods disclosed herein. Itis also appreciated that there are still a large number of other ways inwhich line 438 can be secured to an implant. For example, the line canbe welded, press fit, or attached by a variety of different types offasteners such as bolts, rivets, or clamps.

Depicted in FIGS. 32A and B is another alternative embodiment of acondylar implant 326. Like elements between condylar implants 300 and326 are identified by like reference characters. In contrast to condylarimplant 300 which is fixed and rigid, condylar implant 326 is mobile.Specifically, in condylar implant 326 the body comprises a lower bearingplate 328 from which the flexible line projects and an upper bearingplate 330 that is slidably mounted on lower bearing plate 328.

Lower bearing plate 328 has a top surface 332 and an opposing bottomsurface 334 with a perimeter edge 335 extending therebetween. Pocket 316is formed on bottom surface 334 to receive inlay 320. In thisembodiment, stem 304 is shown elongated and at an angle. If desired,stem 304 can be formed long enough so that it extends directly into thetunnel formed on the tibia. Likewise, stem 304 can be oriented at anyangle to correspond with the tunnel. Top surface 332 is substantiallyflat or inwardly arched and extends between an anterior end 336 and aposterior end 338. A track 340 is recessed on top surface 332. Track 340has an open mouth extending through perimeter edge 335 at anterior end336 and longitudinally extends toward posterior end 338. Track 340 isbounded by a substantially flat floor 343 having a sidewall 344upstanding therefrom. Sidewall 344 comprises a recess groove 345 whichextends along floor 343 and an outwardly projecting lip 346 whichprojects along top surface 332. As such, the opposing sidewalls 344 oftrack 340 form a mortis.

Upper bearing plate 330 comprises top articular surface 306 and a bottomsurface 348 which each extend between an anterior end 350 and anopposing posterior end 352. Bottom surface 348 has a configurationsubstantially congruent to top surface 332 of lower bearing plate 328.Projecting from bottom surface 348 is an elongated key 354 which extendsfrom toward anterior end 350 to toward posterior end 352. Key 354 has asidewall 356 that is substantially complementary to sidewall 344 of tack340 such that key 354 forms a tenon that can slide into track 340 frommouth 342. In this position key 354 can freely slide along track 340 butis prevented from vertically separating from track 340.

During use, upper bearing plate 330 can slide posterior-anterior onlower bearing plate 328 as the femoral condyle rotates on top articularsurface 306. This ability of upper bearing plate 330 to slide minimizeshigh stress points between the femoral condyle and upper bearing plate,thereby minimizing wear. Furthermore, because bearing plates 328 and 330slide against each other on congruent surfaces, both of bearing plates328 and 330 can be comprised of metal without producing undue wear. Inother embodiments, bearing plates 328 and 330 can be comprised ofplastics, ceramics, or composites of different materials. In addition,bearing plates 328 and 330 can be made of the same or differentmaterials.

Although key 354 and track 340 are shown as being linear, in alternativeembodiments they can be congruently curved to more naturally correspondto the bending movement of the knee. For example, depicted in FIGS. 33Aand B is another alternative embodiment of a condylar implant 360 whichincludes an upper bearing plate 361 and a lower bearing plate 362. Inthis embodiment, lower bearing plate 362 includes a track 363 that iscurved along the length thereof. Upper bearing plate 361 includes anelongated key 364 having a curve complementary to track 363 such thatkey 364 can freely slide within track 363. As previously discussed, key364 and track 363 can also be arched or curved in a vertical plane.

Depicted in FIG. 34 is one embodiment of an anchor assembly 810 used tosecure condylar implant 300 to tibia 12. Anchor assembly 810 comprises abone anchor 812 that operably connects with a lock 813. As discussedbelow in greater detail, bone anchor 812 is selectively placed by afirst drive 814 while lock 813 is selectively placed by a second driver816.

Turning to FIG. 35, bone anchor 812 comprises a tubular body 818 havinga substantially cylindrical configuration. Body 818 includes an interiorsurface 820 and an exterior surface 821 that each extend between aproximal end 822 and an opposing distal end 823. Distal end 823 tapersto a reduced nose 824. Formed at proximal end 822 is an engaging head827 having an exterior surface with a transverse cross section that ispolygonal or any other non-round configuration. As a result, firstdriver 814 can connect with engaging head 827 to selectively rotate boneanchor 812. Encircling and radially outwardly projecting from exteriorsurface 821 are one or more helical threads 825. Threads 825 can beconventional or self-taping and extend radially outward beyond the outerperimeter of engaging head 827. In alternative embodiments, threads 825can be replaced by ridges, barbs, or other bone engaging structures usedin conventional bone anchors. Bone anchor 825 can be formed of abiocompatible metal, a bioabsorbable polymer, a bioactive ceramic, orany other desired material.

As depicted in FIG. 36, interior surface 820 bounds a channel 826longitudinally extending through bone anchor 812. Extending proximal todistal, interior surface 820 comprises a threaded portion 828, afrustoconical tapered portion 830, and a constricted cylindrical portion833.

Returning to FIG. 35, in the embodiment depicted, lock 813 comprises acollet. In general, lock 813 has a proximal end 836, an opposing distalend 838, and a channel 840 extending therebetween. More specifically,lock 813 comprises a tubular body 846 extending from proximal end 836 toa second end 850. Encircling and radially, outwardly projecting frombody 846 are one or more helical threads 854. Threads 854 are configuredto engage with threaded portion 828 of bone anchor 812. At least aportion of channel 840 extending through body 846 is bounded by aninterior, surface 847 having a polygonal or other non-circulartransverse cross section so that second driver 816 (FIG. 34) can besecured therein for selective rotation of lock 813.

Projecting from second end 850 of body 846 are a plurality of flexiblefingers 856. As depicted in FIG. 37, four finger 856 are provided witheach finger 856 being separated by a slot 857 extending along the lengthof fingers 856. In alternative embodiments, two or more fingers 856 canbe used. The distal end of each finger 856 is radially, inwardlytapered.

As depicted in FIG. 38, during operation lock 813 is partially screwedinto proximal end 822 of bone anchor 812. In this position, with fingers856 unflexed, line 438 is passed through channels 826 and 840. Asdiscussed below in greater detail, when it is desired to secure line 438relative to bone anchor, lock 813 is advanced further into bone anchor812 until tightly secured therein. In so doing, fingers 856 of lock 813bias against tapered portion 830 of bone anchor 812 which causes fingers856 to radially, inwardly constrict and securely engage line 438. Inthis position, line 438 is prevented from being pulled in eitherdirection. However, line 438 can again be freely moved by simplyunscrewing lock 813 from within bone anchor 812 so that fingers 856 areable to freely, outwardly flex.

Returning to FIG. 34, first driver 814 comprises a tubular shaft 862having a proximal end 863 and an opposing distal end 864. A handle 865is formed at proximal end 863. A passage 866 extends through shaft 862and handle 865 so that line 438 can pass completely through first driver814. Passage 866 at distal end 864 has an interior surface that iscomplementary to the exterior surface of engaging head 827 of boneanchor 812. As such, first driver 814 can be selectively coupled withbone anchor 812 for selective rotation of bone anchor 812.

Second driver 816 also comprises a tubular shaft 867 having a proximalend 868 and an opposing distal end 870. A tubular handle 872 is mountedproximal end 868. As such, a passage 874 extends the length of seconddriver 816 so that line 438 can extend completely therethrough. Distalend 870 of shaft 867 terminates at a tip 875. Tip 875 has aconfiguration complementary to channel 840 at proximal end 836 of lock813. As such, second driver 816 can be selectively coupled with lock 813for selective rotation of lock 813.

Turning to FIG. 39, to facilitate mounting of condylar implant 300, withthe second end of line 438 connected to implant 300, first end 439 ofline 438 is passed through tunnel 400 from second end 404 (FIG. 17) tofirst end 402. In one embodiment this is accomplished by passing aninstrument up through tunnel 400 from first end 402 to second end 404.The instrument is then used to grab first end 439 of line 438 and pullit down through tunnel 400. Other techniques can also be used.

Line 438 is continually pulled through tunnel 400 to remove all slack.With the slack removed, condylar implant 300 is slid onto resectedsurface 234 so as to fit within pocket 278. Here it is noted thatbecause condylar implant 300 has a relatively low profile, condylarimplant 300 can be easily passed through the relatively small incisionthat was originally formed over the medial meniscus. This is in contrastto other conventional procedures where larger incisions must be made toeither allow placement of an implant having a large stem that isembedded within the bone for securing or to provide access room toenable securing the implant by passing screws down through the top of atleast a portion of the implant.

Once implant 300 is positioned, bone anchor 812 is fed onto line 438.Specifically, with lock 813 partially inserted into bone anchor 812, asdiscussed above with reference to FIG. 38, first end 439 of line 438 ispassed distal to proximal through channels 826 and 840 of bone anchor812 and lock 813. First end 439 of line 438 then is passed distal toproximal through passage 866 of first driver 814 so that first driver814 can removably couple with bone anchor 812. It is appreciated thatthe above steps can be performed in a variety of different sequences.For example, line 428 can be passed through bone anchor 812 and lock 813separately before they are connected together.

First driver 814 is then used to screw bone anchor 812, having lock 813therein, into first end 402 of tunnel 400. Bone anchor 812 is advanceduntil proximal end 822 passes into tibia 12. In one embodiment, a tap,not shown, is used to initially thread the interior surface of tunnel400 at first end 402. Alternatively, bone anchor 812 can beself-tapping.

Next, a tensioner 878 is used to tension line 438. As depicted in FIGS.40 and 41, tensioner 878 comprises a frame 880 having a proximal end 881and an opposing distal end 882. Distal end 882 removably connects tohandle 865 of fist driver 814. A channel 884 is formed within a portionof frame 880. Rotatably disposed within channel 884 is a threaded shaft886. A portion of shaft 886 extends beyond proximal end 881 and has ahandle 888 connected thereto. Mounted on threaded shaft 886 withinchannel 884 is a clamp arm 890. Clamp arm 890 is mounted such thatrotation of shaft 886 by rotation of handle 888 causes clamp arm 890 toselectively advance along shaft 886 depending on the direction ofrotation.

Positioned on clamp arm 890 is a stop plate 892. An eccentricallymounted cam 894 is rotatably mounted to clamp arm 890 and is springbiased against stop plate 892. A handle 895 projects from cam 894.Depressing handle 895 causes cam 894 to rotate away from stop plate 892.Line 438 can then be placed between cam 894 and stop plate 892. Whenhandle 895 is released, cam 894 spring biases against stop plate 892causing line 438 to be secured therebetween. Because cam 894 iseccentrically mounted, the more tension on line 438 toward first driver814, the greater the force applied by cam 894 to secure line 438 inplace.

Turning to FIG. 42, once bone anchor 812 has been mounted to tibia 12,first end 439 of line 438 is passed distal to proximal through passage874 in second driver 816. Proximal end 870 of second driver 816 is thenadvanced proximal to distal through passage 866 of first driver 814.Second driver 816 is advanced until distal tip 875 couples with lock813. Next, tensioner 878 is connected with handle 865 of first driver814. Line 438 extending from second driver 816 is then connected toclamp arm 890 by cam 894 as discussed above. Handle 888 of tensioner 878is then rotated so that clamp arm 890 is moved along threaded shaft 886away from second driver 816. In so doing, a tension force is applied toline 438. A force measuring device, such as a transducer, can be coupledwith tensioner 878 for measuring the tension force applied to line 438.In turn, the tension force on line 438 is the same force used to biasimplant 300 against tibia 12. When a sufficient tension force is appliedto line 438, handle 872 of second driver 872 is rotated, thereby causinglock 813 to secure line 438 within bone anchor 812. In one embodiment,the tension force applied to line 438 is in a range between about 25pounds (110 N) to about 300 pounds (1,335 N) with about 150 pounds (670N) to about 250 pounds (1,110 N) being more common. Other forces canalso be applied.

Once lock 813 is secured in place, tensioner 878, second driver 816 andfirst driver 814 are removed. One of the unique features of thisembodiment of the present invention is that should the surgeon wish tomake some modification to the implant or related anchor system, lock 813can simply be loosened using second driver 816 to allow the desiredmovement or adjustment. The above process can then be repeated toresecure implant 300 in place. Once properly position and secured, line438 is severed just proximal of lock 813. Even after line 438 issevered, however, further tension can be applied to line 438 by backingbone anchor 812 back toward first end 402 of tunnel 400 using firstdriver 814. Closing procedures for the tissue are then performed.

It is appreciated that the same above process can be used for securingimplant 300 to tibia 12 using tunnel 90 as shown in FIG. 10.Furthermore, a first tunnel 90 can be formed for use in resecting tibia12 following which a second tunnel 400 can be formed for placement ofline 438 and anchor assembly 810. It is likewise appreciated that manyof the mounting steps can be modified or performed in an alternativeorder. For example, in one method condylar implant can be positioned onresected surface 234 prior to having line 438 connected thereto. Aspreviously discussed with regard to FIG. 22, a driver can then be usedto secure line 438 to implant 300 by passing retainer 444 through tunnel400 from first end 402 to second end 404 where retainer is then screwedinto implant 300, thereby securing line 438 to implant 300.

In one embodiment of the present invention means are also provided forsecuring line 438 to bone anchor 812. One example of such meanscomprises lock 813. In alternative embodiments lock 813 can have avariety of different configurations or be replaced with a variety ofdifferent structures. For example, any number of different wedges,cleats, or cams can be placed in bone anchor 812 so that line 438 can bepulled one way through bone anchor 812 but is prevented from beingpulled back. In yet other embodiments, once line 438 is tensioned, alock can be crimped or otherwise secured to line 438. The lock wouldthen bias against bone anchor 812 to prevent line 438 from being pullingback through bone anchor 812. Examples of various locks which can beused are disclosed in U.S. Pat. No. 5,702,397, issued Dec. 30, 1997 andU.S. patent application Ser. No. 09/970,559, filed Oct. 3, 2001. Thebone anchors with related line locking structures disclosed in U.S. Pat.No. 5,702,397 and application Ser. No. 09/970,559 are incorporatedherein by specific reference.

Depicted in FIG. 43 is one embodiment of a system used for mountingimplant 470 as previously discussed with regard to FIG. 31. In thisembodiment, two tunnels 400A and 400B extend from lateral side 14 oftibia 12 to resected surface 234. Tunnels 400A and B can be formedhaving parallel alignment or any desired angle. Furthermore, tunnels400A and B can be formed by moving tunnel guide 370 (FIGS. 20 and 21) totwo locations at which the tunnels are drilled or tunnel guide 370 canbe formed having two adjacent guide sleeves 378 mounted on the brace372. Each tunnel guide 370 can then be used for forming correspondingtunnels 400A and B.

To secure implant 470 to tibia 12, first end 439 of line 438 is passedproximal to distal through channel 826 in first bone anchor 812A. Firstend 439 is then passed up through first tunnel 400A, though passages 475on implant 470 (FIG. 31), down through second tunnel 400B, and finallythrough second bone anchor 812B and lock 813. First driver 814 is usedto drive bone anchors 812A and B into corresponding tunnels 400A and B.Line 438 is pulled down through second tunnel 400B so as to remove theslack therefrom. In so doing, enlarged head 442 on second end 440 ofline 438 is advanced into first bone anchor 812A where head 442 issecurely wedged within tapered portion 830 of channel 826 (FIG. 36).With second end 440 of line 438 secured to bone anchor 812A, the sameprocess previously discussed with regard to FIG. 42 is used tension line438 and secure line 438 to second bone anchor 812 using lock 813.

It is appreciated that first bone anchor 812A can be replaced with avariety of alternative structures that prevent second end 440 of line438 from being pulled through first tunnel 400A. For example, the firstbone anchor can simply comprise an enlarged washer that capturesenlarged head 442 but is too big to pass through tunnel 400A. In yetother embodiment, the first bone anchor can simply comprise an enlargedtubular wedge that wedges into tunnel 400A but cannot pass therethrough.In still other embodiments, line 438 can be formed without enlarged head442. In this embodiment, lock 813 or other wedging or locking typestructure can be used to secure second end 440 of line 438 to the firstbone anchor. Where two separate lines 438 are connected to an implant,each line is extended through a corresponding tunnel. The processdiscussed with regard to FIG. 42 is then separately performed for eachseparate line.

By using the above discussed implants and anchor assemblies with thecorresponding methods and instruments, it is appreciated that theimplants can be securely mounted to tibia 12 using procedures that areminimally invasive. Furthermore, because the implants are only securedin place after they are positioned on the proximal end of the tibia, thesurgeon can easily switch out different sizes of implants when trying todetermine an appropriate fit. Likewise, because the anchoring assembliesare operated through the first end of the tunnel which is remote fromthe implant, the inventive anchoring assemblies enable the surgeon toeasily adjust the placement of the implant during initial positioningand to subsequently remove the implant should a replacement be requiredat a later date.

Furthermore, as a result of using a flexible line to secure theimplants, the surgeon can select the best location for forming thetunnel and mounting the bone anchor at the time of the operation. Thatis, the surgeon is not limited to forming the tunnel at a predefinedlocation based on structural limitations imposed by the implant. Inaddition, because the line can be relatively small, the size of therequired tunnel can be minimized, thereby minimizing the amount of bonethat needs to be removed when forming the tunnel. Replacement of a wornor damaged implant is also relatively easily achieved by cutting theline.

Because the inventive implants, anchor assemblies, tissue preparationinstruments, and corresponding methods each produce independently uniquebenefits, it is appreciated that theses various features can be usedindependently with other conventional apparatus and techniques. Forexample, in one embodiment a larger incisions can be made at the knee ofa patient and the proximal end of tibia 12 resected using conventionalresection techniques. In this embodiment, tunnel 90 and/or 400 can beformed either before or after the resection of tibia 12. Once the tibiais resected and the tunnel formed, the above procedure can then be usedto secure condylar implant 300. In another alternative, tunnel 90 can beformed and tibia 12 resected as discussed above. However, once tibia 12is resected, a conventional implant can be mounted on tibia 12 usingconventional techniques.

The above discussed embodiments relate to mounting a condylar implant ontibia 12. As previously mentioned, however, the present invention canalso be used to mount other types of implants on other articulationsurface so as to achieve one or more of the same benefits. For example,depicted in FIG. 44 is a full tibial implant 500. Tibial implant 500comprises a tray 502 and a bearing plate 504. Tray 502 has a top surface506 and an opposing bone apposition surface 509. Top surface 506 boundsa pocket 508 which is configured to receive and lock bearing plate 504.Bearing plate 504 has a top articular surface 510 and a bottom surface512 which is selectively snap fit within pocket 508 of tray 502.

In one embodiment, tray 502 is comprised of metal while bearing plate504 is comprised of a polymeric material. It is noted that bearing plate504 and tray 502, as discussed above, are well known in the art and canbe replaced with a variety of other conventional bearing plates 504 andtrays 502 used in full tibial implants. The distinction over the priorart, however, is that tray 502 has been modified so that line 438, aspreviously discussed, is connected to tray 502 so as to project frombone apposition surface 509.

As also depicted in FIG. 44, proximal end 10 of tibia 12 has beenuniformly resected so as to form a resected articulation surface in theform of a tibial plateau 514. Tunnel 90 includes second end 96 formed ontibial plateau 514 and first end 94 spaced apart from tibial plateau514. Tibia 12 can be resected to form tibial plateau 514 by using any ofthe methods or combination of methods disclosed herein or by using otherconventional techniques. For example, tunnel 90 can be formed using themethod disclosed for forming tunnel 400. Depending on the method used,tunnel 90 can be formed before or after resection of tibia 12.

Once tibia 12 is resected, line 438 is passed through tunnel 90 and tray502 is positioned on tibial plateau 514 so that the location where line438 connects with tray 502 aligns with second end 96 of tunnel 90. Oneof the above discussed anchor assemblies is then used to secure tray 502to tibia 12. Bearing plate 504 can be secured to tray 502 either beforeor after securing tray 502 to tibia 12.

It is appreciated that the various alternatives discussed above withregard to how line 438 can be mounted to tray 502 and the number andposition of inlays are also applicable to tray 502. Furthermore, to helpprevent unwanted movement of tray 502, resected surface 514 can becontoured with a pocket of which bone apposition surface 509 has acomplementary configuration. Likewise, any number of spikes, fins, orprojections can be formed so as to project from bone apposition surface509.

Features of the present invention can also be used for mounting afemoral implant on the distal end of a femur. Like elements betweendifferent embodiments are identified by like reference characters. Forexample, depicted in FIG. 43 is a distal end 532 of a femur 530 having amedial side 540 and a lateral side 542 that extend between an anteriorside 538 and a posterior side 536. Distal end 532 of femur 530terminates at a lateral condyle 535 and a medial condyle 537.

Mounted on medial condyle 537 is a guide template 900. Guide templatebounds an elongated opening 902 that extends therethrough and which isconfigured to closely fit over a predefined portion of an articulationsurface of medial condyle 537. Opening 902 bounds the area where thebone is to be resected and a condylar implant mounted. Guide template iscurved and comes in a variety of different sizes and shapes so that aproper fit can be made on medial condyle 537. Once a proper sized andfitting guide template 900 is positioned, guide template 900 is securedin place by spaced apart screws 904 that are screwed through screw holesin guide template 900 and into the medial side of femur 530. It isappreciated that the various alternatives as discussed above with regardto guide template 236 are also applicable to guide template 900.

In one embodiment, a milling head 906 is used to facilitate resection ofmedial condyle 537 bounded by guide template. Milling head 906 has asubstantially hour-glass configuration and has an elongated handle 908projecting from one side and a stem 909 projecting from the other.Milling head 906 is positioned within opening 902 in a medial-lateralorientation with handle 908 projecting from medial side 540 of femur530. In this orientation, milling head 906 is rapidly rotated and thenselectively moved within opening 902 anterior-posterior. This movementis guided by the sides of guide template 900 bounding opening 902.Milling head 906 grinds away the bone bounded within opening 902 untilhandle 908 and stem 909 rest against guide template 900, therebypreventing milling head 906 from descending further into the bone.

Because guide template 900 is curved anterior-posterior, the milledpocket formed by milling head 906 is outwardly archedanterior-posterior. Likewise, because milling head 906 is curvedlateral-medial, the milled pocket is also outwardly archedlateral-medial. As such, the recessed pocket produced by milling head906 is arched anterior-posterior and lateral-medial. Again, this pocketconfiguration enables the formation of a low profile implant havingsubstantially uniform thickness and strength. Furthermore, the pocketformation produces a stable platform for the implant having acomplementary configuration. In alternative embodiments, it is againappreciated that milling head 906 can have a variety of differentconfigurations.

As depicted in FIGS. 46 and 47, a rasp 910 can be used to form roundedends for the recessed pocket. Rasp 910 comprises an elongated handle 912having a cutting mount 913 mounted on the end thereof. Cutting mount 913has a generally semi-circular transverse cross section with a concavebearing face 914. Formed on bearing face 914 are a plurality of cuttingteeth 915. Extending through cutting mount are a plurality of slotsthrough which bone fragments can be removed. Cutting mount 913 isconfigured to be reciprocally moved within the opposing ends of opening902 of guide template 900 so as to form rounded ends on the pocketformed to receive the implant.

Once the recessed pocket is finished, a centering template 918 ismounted within the recessed pocket that is still bounded by guidetemplate 900. As depicted in FIG. 48, centering template 918 comprises amounting plate 920 having a handle 922 projecting therefrom. Mountingplate 920 has substantially the same size and contouring as opening 902of guide template 900. As such, mounting plate 920 is substantiallyfixed when received within opening 902. Formed on an upper surface ofmounting plate 920 is a centering indent 924. When mounting plate 920 ispositioned within opening 902, indent 924 is located above the locationwhere tunnel 400 is to enter the recessed pocket formed on medialcondyle 547.

Once centering template 918 is positioned, tunnel guide 370 (aspreviously discussed with regard to FIGS. 20 and 21) is mounted on femur530 to facilitate the formation of tunnel 400. Specifically, tip 391 ofalignment arm 386 is positioned on indent 924 of centering template 918while guide sleeve 378 is biased against lateral side 542 of femur 530.Again, guide sleeve 378 can be positioned at any optimal location onfemur 530 for the formation of tunnel 400. After the tunnel guide 370 ispositioned, a guide wire and/or other drilling structures used to formtunnel 400 through femur 530 using guide sleeve 378 as a guide. This issubstantially the same process as previously discussed with regard toFIG. 21.

In one alternative embodiment, centering template 918 and tunnel guide370 can be eliminated. That is, tunnel 400 can be drilled starting atthe recessed pocket and extending to the lateral or medial side of thefemur. Because it is less critical where tunnel exits on the lateral ormedial side, tunnel guide 370 is not required but could, if desired,still be used. This process could also be used on the tibial side.

Once tunnel 400 is formed, tunnel guide 370, centering template 918, andguide template 900 are removed from femur 530. A femoral condylarimplant 928 is then positioned within the recessed pocket. As depictedin FIGS. 49 and 50, in one embodiment femoral condylar implant 928comprises a body 930 having a curved aticular surface 931 and anopposing bottom surface 932. A pair of pockets 934 A and B are formed onbottom surface 932 and are separated by a bridge 935. Disposed withineach pocket 934A and B is an inlay 936A and B of porous bone ingrowthmaterial. Bridge 935 and inlays 936A and B substantially comprise a boneapposition surface 938. Bone apposition surface has a configurationcomplementary to the formation of the recessed pocket formed on medialcondyle 537. Connected to bridge 935 is line 438. It is appreciated thatthe various alternatives as previously discussed with regard to thetibial condylar implants and the methods for connecting line 438 theretoare also applicable to femoral condylar implant 928.

Finally, turning to FIG. 51, femoral condylar implant 928 is secured tofemur 530 using anchor assembly 810 (FIG. 35) and the instruments andtechniques as previously discussed with regard to FIGS. 34-43. The samealternatives as previously discussed with regard to FIGS. 34-43 are alsoapplicable to the attachment of femoral condylar implant 928. Forexample, two separate tunnels can be formed on femur 530 that intersectwith the recessed pocket on medial condyle 537. Opposing ends of asingle line 438 slidably connected to implant 928 can be passed throughthe separate tunnels and secured with corresponding bone anchors.Alternatively, two separate and discrete lines 438 can be connected tofemoral condylar implant 928, each line being disposed in a separatetunnel.

The present invention can also be used in mounting a total femoralimplant. For example, depicted in FIG. 52, the articulation surface atdistal end 532 of femur 530, notably the femoral medial condyle andlateral condyle, have been resected so as to form a resectedarticulation surface 534. Tunnel 90 is formed on femur 530. Second end96 of tunnel 90 extends through resected articulation surface 534 whilefirst end 94 of tunnel 90 is formed on medial side 540 at a locationspaced apart from resected articulation surface 534. Tunnel 90 can bebored through femur 530 at an oblique angle as reflected in FIG. 30. Inone embodiment the angle a is in a range between about 15° to about 50°with about 20° to about 40° being more common. Other angles can also beused. Tunnel 90 can be bored by making an incision in the skin adjacentfemur 530, properly orienting a tubular alignment guide, then boringtunnel 90 with a drill through the alignment guide. In one embodimenttunnel 90 can be formed using a modified guide assembly similar to guideassembly 30 as previously discussed. Tunnel 90 can also be formed usingthe same types of methods and tools used to form tunnel 400.

Resected articulation surface 534 can be formed using the presentinvention or other conventional resecting techniques. For example,depicted in FIG. 53 is a femoral rasp assembly 515 which has componentssimilar to rasp assembly 100 previously discussed with regard to FIGS.6-9. Femoral rasp assembly 515 comprises a substantially U-shaped raspbody 516, pivot arm 105, rasp guide 106, and cover plate 108.

Insertion handle 160 is show removably disposed over pivot arm 105 and,if desired, can be used to initially place rasp assembly 515 on femur530. Rasp body 516 has a substantially concave cutting surface 517having a plurality of ridges 118 formed thereon. Ridges 118 eachterminate at sharpened cutting edge 120. It is appreciated that ridges118 and cutting edges 120 can be at any desired orientation orcombination of different orientations that facilitate cutting.

As with rasp assembly 100, extending through rasp body 516 is guide slot122 and opening 128. Rasp guide 106 is received within guide slot 122 sothat forks 132A-B pass through opening 128. Cover plate 108 secures raspguide 106 within guide slot 122.

During operation, rasp assembly 515 is mounted on the distal end offemur 530 such that forks 132A and B of rasp guide 106 are aligned withsecond end 96 of tunnel 90. Once rasp assembly 515 is positioned,retention rod 102 (FIGS. 8 and 9) is advance within tunnel 90 from firstend 94 and connected to rasp guide 106 as previously discussed.

Once retention rod 102 is secured to rasp assembly 515, insertion handle160 is removed and a reciprocal driver, such as a reciprocal saw, isconnected pivot arm 105. While holding rasp guide 106 substantiallystationary by holding onto retention rod 102, the reciprocal driverrapidly reciprocates rasp body 516 so that cutting edges 120 resects thedistal end of femur 530. In the embodiment depicted, rasp body 516 isonly designed to resect the medial side of the distal end of femur 530.A complementary rasp assembly can then be used to resect the lateralside of the distal end of femur 530 using a second tunnel 90 extendingthrough lateral side 542 of femur 530, thereby forming resectedarticulation surface 534.

In yet other embodiments, it is appreciated that multiple differentrasp, assemblies with one or more different tunnels can be used toresect femur 530 or a single rasp assembly can be configured tosimultaneously resect the entire distal end of femur 530. For example,depicted in FIG. 54 is another embodiment of a femoral rasp assembly520. Rasp assembly 520 comprises an arched rasp body 522, pivot arm 105,rasp guide 106, and cover plate 108. Rasp body 522 has a substantiallyconcave cutting surface 524 having a plurality of ridges 118 formedthereon. As with rasp body 516, extending through rasp body 522 is guideslot 122 and opening 128. Rasp guide 106 is received within guide slot122 so that forks 132A-B pass through opening 128. Cover plate 108secures rasp guide 106 within guide slot 122.

Rasp body 522 is configured to primarily resect the anterior surface atthe distal end of femur 530. As such, a corresponding tunnel 90 can beused on femur 530 to ensure proper placement of rasp body 522 duringresection. A complementary rasp body is then be used to resect theremainder of the distal end of femur 530. For example, depicted in FIGS.58-64 are alternative embodiments of two piece femoral implants.Corresponding two piece rasp bodies can be formed to resect thecorresponding surfaces that receive the pieces of the femoral implants.

Furthermore, it is also appreciated that although resected articulationsurface 534 is shown having a plurality of planar faces, in alternativeembodiments the one or more rasp assemblies can be configured so as toproduce resected articulation surface 534 having a continuous smootharched surface or combinations of different surfaces.

In other embodiments, it is appreciated that the various rasps can beused without the formation of tunnels or the use of retention rods. Thatis, the rasps can simply be biased against the bone. Likewise, by usingguides similar to guide 214 depicted in FIG. 12, an oscillating orreciprocating saw can be used to form the resected surfaces depicted inFIG. 52. In yet other embodiments, a combination of sawing and raspingcan be used to form the desired resected surface.

In one embodiment of the present invention, a femoral implant 550 isprovided incorporating features of the present invention. As depicted inFIGS. 52 and 55, femoral implant 550 comprises a substantially U-shapedbody 552 having an articular surface 554 and an opposing bone appositionsurface 556 which each extend between an anterior end 558 and aposterior end 560. Articular surface 554 is configured to mate with atibia or tibial implant while bone apposition surface 556 is configuredto mate with resected articulation surface 534 of femur 530.

More specifically, body 552 of femoral implant 550 comprises asubstantially U-shaped medial condyle 562 and a substantially U-shapedlateral condyle 564. Condyles 562 and 564 are connected together atanterior end 558 but are spaced apart at posterior end 560 so that anelongated slot 565 is formed thereat. Mounted to femoral implant 550 soas to project from bone apposition surface 556 of medial condyle 562 isline 438. During use, first end 439 of line 438 is passed through tunnel90 from second end 96 to first end 94. Femoral implant 550 is thenpositioned on resected articulation surface 534 so that the positionwhere line 438 connects with femoral implant 550 is aligned with secondend 96 of tunnel 90. Here it is appreciated that because there are noposts projecting from bone apposition surface 556, femoral implant 550can be slide on to resected articulation surface 534 lateral to medialor medial to lateral through a medial or lateral incision on the knee ofthe patent. As a result, it is not necessary to openly expose distal end532 of femur 530 during placement of femoral implant 550. As depicted inFIG. 56, once femoral implant 550 is positioned, anchor assembly 810 oralternatives thereto, is used to secure femoral implant 550 to femur530.

In one alternative embodiment depicted in FIG. 55, a second line 438Acan connected to femoral implant 550 so as to project from boneapposition surface 556 of lateral condyle 564. By passing second line438A through a second tunnel on the lateral side of femur 530, a secondanchor assembly can be used to further secure femoral implant 550 tofemur 530. Alternatively, second line 438A and the second anchorassembly can be used instead of the first line 438 and correspondinganchor assembly 810. In yet another alternative, a single line 438 canbe slidably mounted to femoral implant 550 with opposing ends of theline being secured within separate tunnels.

Depicted in FIG. 57 is an alternative embodiment of a femoral implant580 incorporating features of the present invention. Again, likeelements of different embodiments are identified by like referencecharacters. In contrast to bone apposition surface 556 beingsubstantially flat, an elongated post 626 is formed projecting from boneapposition surface 556. An opening 627 extends through the side of post626. An elongated pin 678 has a proximal end 679 and an opposing distalend 680. An enlarged threaded head 682 is formed at proximal end 679. Apolygonal socket 684 is formed on an end face of head 682 to receive adriver. A first bore is formed on resected surface 534 (FIG. 52) offemur 530 to receive post 626. Either before or after femoral implant580 is positioned on resected surface 534 with line 438 extendingthrough tunnel 90, a second bore is formed into or through femur 530lateral to medial or medial to lateral so that the second bore isaligned with opening 627 in post 626. Pin 678 is then advanced into thesecond bore so that pin 678 passes through opening 627 of post 626. Pin678 is then secured in place by screwing threaded head 682 of post 626into the femur. Post 262 thus helps to prevent any unwanted movement offemoral implant 580. As also depicted in FIG. 57, spikes 686 projectfrom bone apposition surface 556. It is appreciated that any number ofspikes, fins, or other forms of projections can be formed on boneapposition surface 556 and can be used in conjunction with orindependent of post 626.

In one embodiment, in addition to using anchor assembly 810 to attachthe femoral implant to the femur 530, a bone cement can be employed tofurther enhance the adhesion of the femoral implant to resected femur530. The bone cement can be applied before and/or during mounting of thefemoral implant. For example, the femoral implant can be partiallyattached and then a syringe or other form of delivery tube used toinject bone cement between the femoral implant and femur 530. Inaddition, a porous or fibrous material, such as a wire mesh, may beattached to bone apposition surface 556 of the femoral implant tothereby foster bone growth between the femoral implant and resectedfemur 530 and/or to provide surface area for attaching the bone cementbetween the femoral implant and resected femur 530. In one embodiment,one or more pockets can be formed on bone apposition surface 556. Aninlay of porous bone ingrowth material, such as previously discussedwith regard to inlay 320, can be secured within the pockets.

Depicted in FIGS. 58-64 are connectible two-piece femoral implantsincorporating features of the present invention. The implants can beused in knee arthroplasty wherein the two parts are independently slidin from the medial or lateral side of the knee through an incision andthen connected and mounted onto resected articulation surface 534 offemur 530. A coupling member, such as a bolt, screw, pin, or the like,can be used to attach one part of the femoral implant to the other.Optionally, one part may be mounted on resected articulation surface 534followed by the other part being connected thereto. One or more lines438 connected to the femoral implant is used in conjunction with acorresponding anchor assembly 810 or alternative thereof, as discussedabove, to connect the femoral implant to femur 530. Because the smallerparts of the two-piece femoral implant can be sequentially insertedthrough an incision, the required incision can be smaller than requiredfor unitary implants.

FIG. 58 is a perspective view of a two-piece femoral implant 602 in adivided state while FIG. 59 is a perspective view of femoral implant 602shown in an assembled state. In one embodiment, femoral implant 602 canbe designated as “end use” in that the entire structure is configured tobe permanently mounted onto the resected articulation surface during aresurfacing procedure and is designed for permanent daily use by apatient.

Femoral implant 602 is centrally divided lateral to medial and comprisesa patellar condyle 603, which includes anterior end 558, and a tibialcondyle 604, which includes posterior end 560. Patellar condyle 603includes at a substantially V-shaped posterior end 606. Posterior end606 terminates at an end face 609 that extends between a medial side 607and a lateral side 608 of patellar condyle 603. A pair of spaced apartlinear passageways 616A-B transversely extend through posterior end 606of patellar condyle 603 so as to enter and exit through end face 609.

Tibial condyle 604 terminates at a V-notched anterior end 610 that iscomplementary to V-shaped posterior end 606 of patellar condyle 603.Anterior end 610 terminates at an end face 611 that also extends betweena medial side 612 and lateral side 614 of tibial condyle 604. A pair ofspaced apart passageways 618A-B transversely extend through anterior end610 of tibial condyle 604 between medial side 612 and end face 611. Apair of threaded sockets 620A-B are formed on end face 611 towardlateral side 614 in alignment with passageways 618A-B.

When patellar condyle 603 and tibial condyle 604 are mated, a joint line605 is formed at the intersection. In one embodiment, joint line 605 ispositioned so that it corresponds to the location of the sulcus of femur530 when femoral implant 602 is mounted on femur 530. In the matedposition, passageways 616A-B, passageways 618A-B, and sockets 620A-B arealigned. As a results, bolts 622 and 624 having threaded ends can bepassed through passageways 616A-B, 618A-B and screwed into sockets620A-B so as to securely connect patellar condyle 603 and tibial condyle604. It is appreciated that bolts 622 and 624 can be replaced with avariety of other structures to connect patellar condyle 603 and tibialcondyle 604.

Femoral implant 602 further comprises line 438 connected to patellarcondyle 603 and/or tibial condyle 604. Again, by extending the one ormore lines 438 though a corresponding tunnel on the femur, anchorassembly 810 or an alternative thereto can be used to secure the lines438 and thus femoral implant 602 to femur 530 as discussed in the aboveembodiments.

Depicted in FIG. 60 is a femoral implant 630 that is substantially thesame as femoral implant 602. The only difference is that interlockingteeth 636 and 638 are formed along posterior end 606 of patellar condyle603 and anterior end 610 of tibial condyle 604, respectively.Interlocking teeth 636 and 638 provide greater engagement and stabilitybetween patellar condyle 603 and tibial condyle 604.

Depicted in FIGS. 61 and 62 is another alternative embodiment atwo-piece femoral implant 640. Femoral implant 640 is centrally dividedanterior to posterior so as to comprise a substantially U-shaped medialcondyle 642 a substantially U-shaped lateral condyle 644. Medial condyle642 has a medial side face 646 and a lateral side face 648. A pair ofspaced apart passageways 650A-B transversely extend through medialcondyle 642 between side faces 646 and 648.

Lateral condyle 644 also has a medial side face 652 and a lateral sideface 654. A pair of spaced apart threaded sockets 656A-B are formed onmedial face 652 of lateral condyle 644. When condyles 642 and 644 aremated, a joint line 662 is formed at the intersection. In oneembodiment, joint line 662 is positioned so that it corresponds to thelocation of the trochlear groove of femur 530 when femoral implant 640is mounted on femur 530. In the mated position, passageways 650A-B arealigned with threaded sockets 656A-B. As a result, fasteners 658 and 660each having a threaded end can be selectively passed through passageways650A-B and screwed into sockets 656A-B so as to secure condyles 642 and644 together. Again, line 438 is mounted to medial condyle 642 and/orlateral condyle 644 to facilitate attachment of femoral implant 640 tofemur 530.

Depicted in FIG. 63 is a femoral implant 670 that is substantially thesame as femoral implant 640. The only difference is that a plurality ofinterlocking teeth 672 and 674 are formed along lateral side face 648 ofmedial condyle 642 and medial side face 652 of lateral condyle 644,respectively. Interlocking teeth 672 and 674 provide greater engagementand stability between medial condyle 642 and lateral condyle 644.

Depicted in FIGS. 64A-D is another embodiment of a two-piece femoralimplant 700 incorporating features of the present invention. Femoralimplant 700 is substantially similar to implant 602 discussed above withregard to FIGS. 58 and 59. As such, like elements are identified by likereference characters. In contrast to implant 602, a plurality of spacedapart holes 702 are formed on end face 609 of posterior end 606 ofpatellar condyle 603. A plurality of spaced apart pegs 704 project fromend face 611 of anterior end 610 of tibial condyle 604. Pegs 704 areformed complementary to holes 702 such that when patellar condyle 603and tibial condyle 604 are mated together, pegs 704 are received withinholes 702 so as to rigidly hold condyles 603 and 604 together.

In contrast to having a pair of bolts transversely extending acrosspatellar condyle 603 in femoral implant 602, femoral implant 700comprises a passageway 706 that extends from lateral side 614 of tibialcondyle 604 to end face 611 at anterior end 610 of tibial condyle 604. Athreaded socket 708 is formed on end face 609 of posterior end 606 ofpatellar condyle 603. When condyles 603 and 604 are mated, passageway706 and socket 708 are aligned. A bolt 710 having a threaded end ispassed through a passageway 706 and screwed into socket 708 so as tosecure condyles 603 and 604 together. In one alternative, acomplementary passageway 706A and socket 708A can also be formed on themedial side of condyles 603 and 604 to provide further engagement by abolt 710A.

Although not required, in the embodiment depicted line 438 is shownconnected to a stem projecting from bone apposition surface 556.Alternatively, one or more lines 438 can connect directly to boneapposition surface 556.

Depicted in FIGS. 65-67 are still other examples of inventive implantsmounted on resected articulation surfaces of other orthopedic joints.For example, depicted in FIG. 65 is femur 530 having a proximal end 750that would normally terminate at a femoral head 752 having anarticulation surface. In the depicted drawing, femoral head 752 has beenresected to from a resected articulation surface 753. In each of theembodiments depicted in FIGS. 65-67, it is appreciated that the resectedarticulation surface can be formed using conventional techniques or byusing a modified version of one or more of the methods disclosed hereinin combination with forming a tunnel.

A proximal femoral implant 754 is shown mounted on resected articulationsurface 753. Implant 754 comprises a body 756 having an articularsurface 758 and an opposing bone apposition surface 760. Articularsurface 758 engages with the acetabular socket while bone appositionsurface 760 biases against resected articulation surface 753.

Tunnel 90 is formed on femur 530 using any desired technique. Second end96 of tunnel 90 is formed on resected articulation surface 753 whilefirst end 94 of tunnel 90 is formed on the shaft of femur 530 at alocation spaced apart from resected articulation surface 753. A line 438is mounted to implant 754 and projects from bone apposition surface 760.Line 438 is passed through tunnel 90 and is secured therein using anchorassembly 810 or an alternative thereto. Anchor assembly 810 and line 438thus combine to secure implant 754 to femur 530.

Depicted in FIG. 66 is a humerus 770 having a proximal end 772 thatwould normally terminate at a humerus head having an articulationsurface. In the depicted drawing, the humerus head has been resected toform a resected articulation surface 774. A proximal humerus implant 776is shown mounted on resected articulation surface 774. Implant 776comprises a body 778 having an articular surface 780 and an opposingbone apposition surface 782. Articular surface 780 engages with thescapula while bone apposition surface 782 biases against resectedarticulation surface 774.

Tunnel 90 is formed on humerus 770. Second end 96 of tunnel 90 is formedon resected articulation surface 774 while first end 94 of tunnel 90 isformed on the shaft of humerus 770 at a location spaced apart fromresected articulation surface 774. A line 438 is connected to implant776 so as to project from bone apposition surface 782 of implant 776.Anchor assembly 810 is disposed within tunnel 90 and is coupled withimplant 776 through line 438 so as to secure implant 776 to humerus 770.

Depicted in FIG. 67 is tibia 12 having a distal end 790 that wouldnormally terminate at an articulation surface such as the inferiorarticular surface and the malleolar articular surface. In the depicteddrawing, distal end 790 of tibia 12 has been resected to form a resectedarticulation surface 792. A distal tibial implant 794 is shown mountedto resected articulation surface 792. Implant 794 comprises a body 796having an articular surface 798 and an opposing bone apposition surface800. Articular surface 798 engages with the talus or an implant thereatwhile bone apposition surface 800 biases against resected articulationsurface 792.

Tunnel 90 is formed on tibia 12. Second end 96 of tunnel 90 is formed onresected articulation surface 798 while first end 94 of tunnel 90 isformed on tibia 12 at a location proximally spaced apart from resectedarticulation surface 792. Line 438 is connected to implant 794 so as toproject from bone apposition surface 800. Line 438 is disposed withintunnel 90 and connected to anchor assembly 810 so as to secure implant794 to tibia 12.

Set forth above are several different embodiments of the presentinvention. It is appreciated that the different features of thedifferent embodiments can be mixed and matched to produce a variety ofother embodiments within the scope of the present invention. By way ofexample and not by limitation, each of the different implants can bemade with or without an inlay of porous bone ingrowth material on thebone apposition surface; each different implant can have one or moredifferent lines that are connected in one or more different ways; andeach different implant can be made as an integral body or two or moreseparate parts. For example, each implant can comprise a metal tray thatis mounted to the bone and a plastic bearing plate that is mounted tothe tray. It is likewise appreciated that the different methods stepsfor the different embodiments can also be mixed and matched and usedwith other techniques. Finally, it is again noted that the implantsdescribed herein are only by way of example and not by limitation. Thepresent invention can also be used in association with resurfacingarticulation surfaces of other orthopedic joints.

Finally, the above embodiments primarily discuss mounting implants onresected articulation surfaces. On occasion, however, a sufficientportion of a natural articulation surface has been worn down orotherwise removed by events other than surgical resection so that it isnot necessary to resect the wear surface which is still functioning as anatural articulation surface. On these occasions, it is envisioned thatthe implant can be mounted directly on the worn natural articulationsurface with minimal or no surgical resection of the articulationsurface.

The present invention may be embodied in other specific forms withoutdeparting from its spirit or essential characteristics. The describedembodiments are to be considered in all respects only as illustrativeand not restrictive. The scope of the invention is, therefore, indicatedby the appended claims rather than by the foregoing description. Allchanges which come within the meaning and range of equivalency of theclaims are to be embraced within their scope.

1. An implant for resurfacing at least a portion of an articulationsurface of a bone, the implant comprising: a body having a first sidewith a top articular surface and an opposing second side with a boneapposition surface, the bone apposition surface being adapted to biasagainst a natural or resected articulation surface of a bone; and anelongated flexible first line coupled to and extending from the body. 2.An implant as recited in claim 1, wherein the body comprises a femoralor tibial implant.
 3. An implant as recited in claim 1, wherein the bodycomprises a unicondylar implant.
 4. An implant as recited in claim 1,wherein the body comprises: a tray having the bone apposition surface;and a bearing plate mounted on the tray, the bearing plate beingcomprised of a polymeric material and having the top articular surface.5. An implant as recited in claim 1, wherein the body comprises: a lowerbearing plate; and an upper bearing plate having the top articularsurface formed thereon, one of the lower bearing plate and upper bearingplate having a track formed thereon while the other has a key thatslidably rides within the track.
 6. An implant as recited in claim 1,wherein the body comprises: a bearing plate having the top articularsurface and an opposing bottom surface, a pocket being formed on thebottom surface of the bearing plate; and an inlay of porous boneingrowth material secured within the pocket.
 7. An implant as recited inclaim 1, wherein the body comprises: a bearing plate having the toparticular surface and an opposing bottom surface, a plurality ofdiscrete pockets being formed on the bottom surface of the bearingplate; and a plurality of discrete inlays of porous bone ingrowthmaterial, each of the plurality of discrete inlays being secured withina corresponding one of the plurality of discrete pockets.
 8. An implantas recited in claim 1, wherein the body comprises: a bearing platehaving the top articular surface and an opposing bottom surface, aprojection extending from the bottom surface, the first line beingcoupled with the projection; and a section of porous bone ingrowthmaterial secured to the bottom surface of the bearing plate adjacent tothe projection.
 9. An implant as recited in claim 1, wherein the bodycomprises a first part and a second part that can be selectivelyconnected together, each of the first part and the second partcomprising a portion of the top articular surface and the boneapposition surface.
 10. An implant as recited in claim 1, wherein thefirst line is coupled to the second side of the body so as to projectaway from the bone apposition surface.
 11. An implant as recited inclaim 1, wherein the first line has a first end that is securely fixedto the body.
 12. An implant as recited in claim 1, wherein the body hasa passage extending through a portion thereof, the first line beingcoupled with the body by being slidably disposed within the passage. 13.An implant as recited in claim 1, wherein the body has a passageextending through a portion thereof, the first line having a first endwith an enlarged head formed thereat, the enlarged head being retainedwithin the passage.
 14. An implant as recited in claim 1, furthercomprising a socket formed on the bone apposition side of the body, aportion of the line being disposed within the socket.
 15. An implant asrecited in claim 1, wherein the first line is coupled with the body attwo discrete, spaced apart locations on the body.
 16. An implant asrecited in claim 1, further comprising an elongated flexible second linecoupled with and extending from the body.
 17. An implant as recited inclaim 1, wherein the first line comprises at least a wire or bradedcable that are comprised of metal.
 18. An implant as recited in claim 1,wherein the first line is comprised of a resiliently stretchablematerial.
 19. An implant as recited in claim 18, wherein the line iscomprised of nickel titanium alloy having pseudo elastic properties. 20.An implant as recited in claim 1, wherein the line has properties suchthat for an unsupported length of the line of 4 cm, the line fails underbuckling when an axial compressive load of 4 N is applied to the line.21. An implant as recited in claim 1, wherein a portion of the linecomprises a resiliently stretchable spring.
 22. An implant system forresurfacing at least a portion of an articulation surface of a bone, thesystem comprising: an implant having a top articular surface and anopposing bone apposition surface; an elongated flexible first linecoupled with the implant so as to extend away from the bone appositionsurface; a bone anchor; and means for securing a portion of the flexibleline to the bone anchor.
 23. An implant system as recited in claim 22,wherein the implant comprises. a femoral implant or a tibial implant.24. An implant system as recited in claim 22, wherein the implantcomprises a unicondylar implant.
 25. An implant system as recited inclaim 22, wherein the implant comprises: a lower bearing plate; and anupper bearing plate having the top articular surface formed thereon, oneof the lower bearing plate and upper bearing plate having a track formedthereon while the other has a key that slidably rides within the track.26. An implant system as recited in claim 22, wherein the implantcomprises: a tray having the bone apposition surface; and a bearingplate mounted on the tray, the bearing plate being comprised of apolymeric material and having the top articular surface.
 27. An implantsystem as recited in claim 22, wherein the implant comprises: a bearingplate having the top articular surface and an opposing bottom surface, apocket being formed on the bottom surface of the bearing plate; and aninlay of porous bone ingrowth material secured within the pocket.
 28. Animplant system as recited in claim 22, wherein the implant comprises: abearing plate having the top articular surface and an opposing bottomsurface, a projection or socket being formed on the bottom surface ofthe bearing plate, the first line being secured to the projection orwithin the socket; a section of porous bone ingrowth material beingsecured to the bottom surface of the bearing plate.
 29. An implantsystem as recited in claim 22, wherein the implant comprises a firstpart and a second part that can be selectively connected together, eachof the first part and the second part comprising a portion of the toparticular surface and the bone apposition surface.
 30. An implant systemas recited in claim 22, wherein the first line has a first end that issecurely fixed to the implant.
 31. An implant system as recited in claim22, wherein the implant has a passage extending through a portionthereof, the first line being coupled with the implant by being slidablydisposed within the passage.
 32. An implant system as recited in claim22, wherein the implant has a passage extending through a portionthereof, the first line having a first end with an enlarged head formedthereat, the enlarged head being retained within the passage.
 33. Animplant system as recited in claim 22, wherein the first line is coupledwith the implant at two discrete, spaced apart locations on the implant.34. An implant system as recited in claim 22, further comprising anelongated flexible second line coupled with and extending from theimplant.
 35. An implant system as recited in claim 22, wherein the firstline comprises at least a wire or braded cable that are comprised ofmetal.
 36. An implant system as recited in claim 22, wherein the firstline is comprised of a resiliently stretchable material.
 37. An implantsystem as recited in claim 36, wherein the line is comprised of shapememory alloy.
 38. An implant system as recited in claim 22, wherein aportion of the line comprises a resiliently stretchable spring.
 39. Animplant system as recited in claim 22, wherein the bone anchor comprisesone or more threads or barbs formed on an exterior surface thereof. 40.An implant system as recited in claim 22, wherein the bone anchor has aninterior surface bounding a channel that extends through the boneanchor, a portion of the first line extending through the channel. 41.An implant system as recited in claim 40, wherein the means for securinga portion of the flexible line to the bone anchor comprises a lock atleast partially disposed within the channel of the bone anchor, the lockbiasing against the flexible line within the channel of the bone anchorso as to secure the line therein.
 42. An implant system as recited inclaim 40, wherein the lock comprises a collet at least partiallydisposed within the channel of the bone anchor and encircling the line,the collet having a plurality of flexible fingers which radiallyinwardly constrict to engage with the line when the collet is advancedinto the channel of the bone anchor.
 43. An implant system as recited inclaim 42, wherein the collet is threadedly engaged with the bone anchor.44. An implant system as recited in claim 22, wherein the line hasproperties such that for an unsupported length of the line of 4 cm, theline fails under buckling when an axial compressive load of 10 N isapplied to the line.
 45. An implant system for resurfacing at least aportion of an articulation surface of a bone, the system comprising: animplant having a top articular surface and an opposing bone appositionsurface; an elongated flexible first line coupled with the implant so asto extend away from the bone apposition surface; a first bone anchorhaving a channel extending therethrough, a portion of the first linebeing disposed within the channel; and a lock engaging with the firstbone anchor and the flexible line so as to secure a portion of the firstline relative to the first bone anchor.
 46. An implant system as recitedin claim 45, wherein the implant comprises a femoral implant or a tibialimplant.
 47. An implant system as recited in claim 46, wherein theimplant comprises a unicondylar implant.
 48. An implant system asrecited in claim 45, wherein the implant comprises: a bearing platehaving the top articular surface and an opposing bottom surface; and asection of porous bone ingrowth material secured to the bottom surfaceof the bearing plate.
 49. An implant system as recited in claim 45,wherein the implant comprises a first part and a second part that can beselectively connected together, each of the first part and the secondpart comprising a portion of the top articular surface and the boneapposition surface.
 50. An implant system as recited in claim 45,wherein the first line is permanently fixed to the implant.
 51. Animplant system as recited in claim 45, further comprising a firstpassage extending through a portion of the implant, the first line beingslidably disposed within the first passage.
 52. An implant system asrecited in claim 51, further comprising a second passage extendingthrough a portion of the implant at a location spaced apart from thefirst passage, the first line being slidably disposed within the secondpassage.
 53. An implant system as recited in claim 45, wherein the firstline comprises at least a wire or braded cable.
 54. An implant system asrecited in claim 45, further comprising a resiliently stretchable springconnected to the line.
 55. An implant system as recited in claim 45,wherein the first line has a first end with an enlarged head formedthereat, the enlarged head being secured to the implant.
 56. An implantsystem as recited in claim 45, further comprising an elongated, flexiblesecond line coupled with the implant.
 57. An implant system as recitedin claim 45, wherein the first bone anchor comprises one or more helicalthreads formed on an exterior surface thereof.
 58. An implant system asrecited in claim 45, wherein the first bone anchor has an interiorsurface bounding the channel that extends from a proximal end to anopposing distal end.
 59. An implant system as recited in claim 58,wherein the channel of the first bone anchor comprises a threadedportion and a radially, inwardly constricting tapered portion.
 60. Animplant system as recited in claim 59, wherein the lock comprises acollet at least partially disposed within the channel of the first boneanchor and at least partially encircling the line, the collet having athreaded section which engages with the threaded portion of the firstbone anchor and a plurality of flexible arms at least partially disposedwithin the tapered portion of the first bone anchor.
 61. An implantsystem as recited in claim 58, wherein an exterior surface of the firstbone anchor at the distal end thereof has a polygonal transverse crosssection adapted to received a driver.
 62. An implant system as recitedin claim 45, further comprising a second bone anchor, the first lineeither extending through or being connected to the second bone anchor.63. An implant system comprising: an implant; an elongated first lineextending from the implant; a first bone anchor, the first line slidablyextending through a portion of the first bone anchor; a first driverremovably coupled with the first bone anchor; and a line tensionerconnected to the first line and the first driver or the first boneanchor.
 64. An implant system as recited in claim 63, wherein theimplant has a top articular surface and an opposing bone appositionsurface.
 65. An implant system as recited in claim 63, wherein theimplant is adapted to replace a portion of an articulation surface of abone at a joint in a patient.
 66. An implant system as recited in claim63, wherein the implant comprises a unicondylar implant.
 67. An implantsystem as recited in claim 63, wherein the implant comprises: a bearingplate having the top articular surface and an opposing bottom surface;and a section of porous bone ingrowth material secured to the bottomsurface of the bearing plate.
 68. An implant system as recited in claim63, wherein the first line is fixed to or slidably mounted on theimplant.
 69. An implant system as recited in claim 63, wherein the firstline comprises at least a wire or braded cable that are comprised ofmetal.
 70. An implant system as recited in claim 63, wherein the firstbone anchor comprises one or more barbs or helical threads formed on anexterior surface thereof.
 71. An implant system as recited in claim 63,further comprising: the first bone anchor having an interior surfacebounding a channel that extends from a proximal end to a distal end ofthe first bone anchor, a portion of the first line extending through thechannel; and the first driver having a channel extending through atleast a portion thereof, the first line passing through the channel ofthe first driver.
 72. An implant system as recited in claim 71, furthercomprising a lock at least partially disposed within the channel of thefirst bone anchor, the lock selectively engaging with the first line.73. An implant system as recited in claim 72, further comprising asecond driver at least partially disposed within the channel of thefirst driver and removably coupled with the lock, the second driverhaving a channel extending through at least a portion thereof, the firstline passing through the channel of the second driver.
 74. An implantsystem as recited in claim 72, wherein the lock comprises a colletthreadedly engaged with the first bone anchor, the collet having asocket formed at a proximal end thereof, a portion of the second driverbeing received within the socket of the collet to facilitate selectiverotation of the collet within the bone anchor.
 75. An implant system asrecited in claim 65, further comprising means for measuring the tensionon the first line caused by the line tensioner.
 76. An implant system asrecited in claim 65, further comprising a second line coupled to theimplant.
 77. An implant system as recited in claim 65, furthercomprising a second bone anchor, the first line either extending throughor being connected to the second bone anchor.
 78. A line locking systemcomprising: an elongated line; a first bone anchor, the line slidablyextending through a portion of the bone anchor; a first lock movablydisposed on the first bone anchor and adapted to selectively engage theline; a first driver removably coupled with the first bone anchor; and aline tensioner connected to the line and the first driver or the firstbone anchor, the line tensioner being adapted to apply a tensioningforce to the line.
 79. A line locking system as recited in claim 78,wherein the line comprises at least a wire or braded cable.
 80. A linelocking system as recited in claim 78, wherein the line comprisessuture.
 81. A line locking system as recited in claim 78, wherein thefirst bone anchor comprises one or more barbs or helical threads formedon an exterior surface thereof.
 82. A line locking system as recited inclaim 78, further comprising: the first bone anchor having an interiorsurface bounding a channel that extends from a proximal end to a distalend of the second bone anchor, a portion of the line extending throughthe channel; and the first driver having a channel extending through atleast a portion thereof, the line passing through the channel of thefirst driver.
 83. A line locking system as recited in claim 82, whereinthe first lock encircles the line and is at least partially disposedwithin the channel of the first bone anchor, the first lock being inthreaded engagement with the first bone anchor.
 84. A line lockingsystem as recited in claim 83, wherein the first lock comprises a collethaving a threaded portion and a plurality of flexible fingers, the firstbone anchor being configured such that as the collet is advanced intothe first bone anchor, the fingers radially inwardly constrict to engagethe line.
 85. A line locking system as recited in claim 78, furthercomprising a second driver removably disposed within the channel of thefirst driver and removably coupled with the first lock, the seconddriver having a channel extending through at least a portion thereof,the line passing through the channel of the second driver.
 86. A linelocking system as recited in claim 85, wherein the first lock has asocket formed at a proximal end thereof, a portion of the second driverbeing received within the socket of the first lock to facilitateselective rotation of the first lock within the first bone anchor.
 87. Aline locking system as recited in claim 78, wherein the line tensioneris connected to the first driver and a portion of the line that haspassed through the channel the second driver.
 88. A line locking systemas recited in claim 78, further comprising means for measuring thetension on the line caused by the line tensioner.
 89. A line lockingsystem as recited in claim 78, further comprising a second bone anchor,the line either extending through or being connected to the second boneanchor.
 90. A line locking system as recited in claim 89, furthercomprising a second lock movably disposed on the second bone anchor andadapted to selectively engage the line.